Anticoagulation and Intracranial Hemorrhage in Patients with Brain Metastases

In a retrospective study, patients receiving direct oral anticoagulants had similar rates of intracranial hemorrhage compared with recipients of low-molecular-weight heparin.

Patients with brain metastases present a clinical challenge because they are at increased risk for spontaneous intracranial hemorrhage (sICH) as well as venous thromboembolism (VTE). Is one class of anticoagulation a better choice than another? Can patients with a history of sICH get another chance at anticoagulation?

To address these uncertainties, investigators examined a multinational, retrospective cohort of 505 patients with metastatic brain cancer receiving either a direct oral anticoagulant (DOAC) or low-molecular-weight heparin (LMWH) for VTE or atrial fibrillation.

Patients receiving DOACs had similar 12-month cumulative incidence of sICH compared with patients receiving LMWH (≈10%), mortality (≈50%), and VTE (≈5%).
In a multivariable…

Reviewing Author

Brady L. Stein, MD, MHS

Disclosures

Leadership Positions in Professional SocietiesAmerican Society of Hematology (Senior Editor, ASH Self-Assessment Program; guideline development)

Brady L. Stein, MD, MHS

Disclosures

Leadership Positions in Professional SocietiesAmerican Society of Hematology (Senior Editor, ASH Self-Assessment Program; guideline development)

Anticoagulation and Intracranial Hemorrhage in Patients with Brain Metastases

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Reviewing Author