Hematology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Medicine, Weill Cornell Medical College, New York, NY.
Blood. 2024 Oct 24;144(17):1781-1790. doi: 10.1182/blood.2023023450.
Venous thromboembolism (VTE) is a common complication in patients with brain tumors. The management of acute VTE is particularly challenging due to an elevated risk of intracranial hemorrhage (ICH). Risk of developing ICH on anticoagulation is influenced by a number of factors including tumor type, recent surgery, concomitant medications, platelet counts, and radiographic features. In patients with a heightened risk for ICH, the benefits of anticoagulation need to be balanced against a likelihood of developing major hemorrhagic complications. Management decisions include whether to administer anticoagulation, at what dose, placement of an inferior vena cava filter, monitoring for development of hemorrhage or progressive thrombus, and escalation of anticoagulant dose. This article discusses the complexities of treating acute VTE in patients with brain tumors and outlines treatment algorithms based on the presence or absence of ICH at the time of VTE diagnosis. Through case-based scenarios, we illustrate our approach to anticoagulation, emphasizing individualized risk assessments and evidence-based practices to optimize treatment outcomes while minimizing the risks of hemorrhagic events in patients with brain tumors.
静脉血栓栓塞症（VTE）是脑瘤患者的常见并发症。由于颅内出血（ICH）的风险增加，急性 VTE 的治疗极具挑战性。抗凝治疗发生 ICH 的风险受多种因素影响，包括肿瘤类型、近期手术、同时使用的药物、血小板计数和影像学特征。对于 ICH 风险较高的患者，需要权衡抗凝治疗的益处与发生重大出血并发症的可能性。管理决策包括是否给予抗凝治疗、给予何种剂量、放置下腔静脉滤器、监测出血或血栓进展情况，以及是否增加抗凝剂剂量。本文讨论了治疗脑瘤患者急性 VTE 的复杂性，并根据 VTE 诊断时是否存在 ICH 制定了治疗算法。通过基于案例的场景，我们展示了我们的抗凝治疗方法，强调个体化风险评估和循证实践，以优化治疗结果，同时最大限度地降低脑瘤患者出血事件的风险。
