Levin J M, Schiff D, Loeffler J S, Fine H A, Black P M, Wen P Y
Division of Neurology, Brigham and Women's Hospital, Boston, MA 02115.
Neurology. 1993 Jun;43(6):1111-4. doi: 10.1212/wnl.43.6.1111.
Venous thromboembolic disease is a frequent complication in patients with intracranial malignancies. Because these patients are often perceived to be at increased risk of intracranial hemorrhage with anticoagulation, inferior vena cava (IVC) filters are frequently used in their treatment. We reviewed the records of 49 patients with intracranial malignancies and venous thromboembolic disease to determine the effectiveness of, and the complications resulting from, treatment. Of the 42 patients receiving IVC filters, a strikingly high percentage (62%) developed complications. Twelve percent developed recurrent pulmonary embolism, while 57% developed either IVC or filter thrombosis, recurrent deep venous thrombosis, or post-phlebitic syndrome. These complications severely reduced the quality of life of the affected patients. Only 15 of our patients were treated with anticoagulation, and seven of these received it because of continued thromboembolic disease. None of these 15 patients had proven hemorrhagic complications. This study suggests that the complication rate of IVC filters in patients with brain tumors is higher than commonly perceived and may outweigh the risk of anticoagulation.
静脉血栓栓塞性疾病是颅内恶性肿瘤患者常见的并发症。由于这些患者常被认为抗凝治疗会增加颅内出血风险，因此下腔静脉（IVC）滤器在其治疗中经常被使用。我们回顾了49例颅内恶性肿瘤合并静脉血栓栓塞性疾病患者的记录，以确定治疗的有效性及并发症。在42例接受IVC滤器治疗的患者中，出现并发症的比例高得惊人（62%）。12%的患者发生复发性肺栓塞，而57%的患者出现IVC或滤器血栓形成、复发性深静脉血栓形成或血栓后综合征。这些并发症严重降低了受影响患者的生活质量。我们只有15例患者接受了抗凝治疗，其中7例是因为持续存在血栓栓塞性疾病而接受治疗。这15例患者均未出现证实的出血并发症。本研究表明，脑肿瘤患者使用IVC滤器的并发症发生率高于通常认知，且可能超过抗凝治疗的风险。
