Rogers Katie, Highsmith Emily, Wang Zhongya, Toale Katy M
Department of Pharmacy, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 90, Houston, TX, 77030, USA.
Department of Pharmacy, The Johns Hopkins Hospital, 401 N Broadway St, Unit 5330, Baltimore, MD, 21287, USA.
Support Care Cancer. 2025 Jun 17;33(7):592. doi: 10.1007/s00520-025-09603-6.
Hospitalized patients with cancer have high rates of venous thromboembolism (VTE) and often receive prophylactic anticoagulation. However, in patients with primary brain tumors or secondary brain metastases, the increased risk of intracranial hemorrhage must be carefully considered. The purpose of this study is to describe the rates of VTE and bleeding in hospitalized patients with primary brain tumors and metastases with and without prophylactic anticoagulation.
In this retrospective, single-center study, adult patients with primary or secondary brain tumors, admitted to the hospital and without a contraindication to prophylactic anticoagulation, were identified. Patients were stratified via adequate prophylaxis, defined as an administration of a prophylaxic dose of anticoagulation for ≥80% of days admitted to the hospital versus inadequate VTE prophylaxis, defined as an administration of a prophylactic dose of anticoagulation for <80% of days admitted to the hospital.
Of the 2908 admissions meeting inclusion criteria, 492 (17%) received adequate VTE prophylaxis and 2416 (83%) received inadequate VTE prophylaxis. Of the 538 patients with high bleed risk cancers, defined as melanoma, renal cell carcinoma, thyroid cancer, choriocarcinoma, and hepatocellular cancer, 493 (92%) of patients received inadequate VTE prophylaxis, and only 45 (8%) received adequate VTE prophylaxis. In the entire cohort, the rate of VTE events during hospitalization was 2% in the adequate VTE prophylaxis group versus 9% in the inadequate VTE prophylaxis group (p < 0.001). Major bleeding events also occurred less frequently in the cohort receiving adequate VTE prophylaxis (1%) compared to inadequate VTE prophylaxis (8%) (p < 0.001). In-hospital mortality was similar between both groups, with a rate of 4% in patients receiving adequate VTE prophylaxis and 7% in patients receiving inadequate VTE prophylaxis (p = 0.051). Of patients who died in the hospital, 9% had a cause of death related to bleeding or thrombosis, all in the cohort receiving inadequate VTE prophylaxis compared to 0% in the adequate group.
Patients with primary brain tumors or secondary brain metastases receiving adequate VTE prophylaxis had a numerically lower rate of VTE events and major bleeding events overall during hospitalization compared to patients receiving inadequate VTE prophylaxis. VTE prophylaxis in hospitalized patients with low bleeding risk metastases and primary brain tumors appears to be safe and effective; however, more data is needed in patients with high bleeding risk metastases due to the low numbers of patients with adequate VTE prophylaxis in this cohort.
癌症住院患者静脉血栓栓塞症（VTE）发生率较高，常接受预防性抗凝治疗。然而，对于原发性脑肿瘤或继发性脑转移瘤患者，必须仔细考虑颅内出血风险增加的问题。本研究的目的是描述接受和未接受预防性抗凝治疗的原发性脑肿瘤和转移瘤住院患者的VTE和出血发生率。
在这项回顾性单中心研究中，确定了入院且无预防性抗凝治疗禁忌证的原发性或继发性脑肿瘤成年患者。患者根据充分预防进行分层，充分预防定义为在入院天数的≥80%给予预防性抗凝剂量，而VTE预防不足定义为在入院天数的<80%给予预防性抗凝剂量。
在符合纳入标准的2908例入院患者中，492例（17%）接受了充分的VTE预防，2416例（83%）接受了不足的VTE预防。在538例高出血风险癌症患者中，定义为黑色素瘤、肾细胞癌、甲状腺癌、绒毛膜癌和肝细胞癌，493例（92%）患者接受了不足的VTE预防，仅45例（8%）接受了充分的VTE预防。在整个队列中，充分VTE预防组住院期间VTE事件发生率为2%，而VTE预防不足组为9%（p<0.001）。与VTE预防不足组（8%）相比，接受充分VTE预防的队列中主要出血事件也较少发生（1%）（p<0.001）。两组的住院死亡率相似，接受充分VTE预防的患者死亡率为4%，接受不足VTE预防的患者死亡率为7%（p=0.051）。在医院死亡的患者中，9%的死亡原因与出血或血栓形成有关，均在接受不足VTE预防的队列中，而充分预防组为0%。
与接受不足VTE预防的患者相比，接受充分VTE预防的原发性脑肿瘤或继发性脑转移瘤患者住院期间总体VTE事件和主要出血事件发生率在数值上较低。对于低出血风险转移瘤和原发性脑肿瘤的住院患者，VTE预防似乎是安全有效的；然而，由于该队列中接受充分VTE预防的患者数量较少，对于高出血风险转移瘤患者还需要更多数据。
