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Safety of long-term anticoagulation in patients with brain metastases

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Abstract

Anticoagulation is thought to be associated with the risk of intracranial hemorrhage (ICH) in patients with brain metastases; however, the data on this topic are limited. This study was conducted to determine the incidence of ICH associated with anticoagulant use in adult patients with brain metastases. Consecutive patients with brain metastases occurring from 2006 to 2014 were identified from a single-institution database. Long-term anticoagulant therapy was defined as outpatient anticoagulation therapy of > 1 month. Chi-square tests and Fisher’s exact test were used to compare rates of ICH by groups. This cohort included 125 patients with brain metastases. Of these, 64 had primary of non-small cell lung cancer (51.2%). Of these patients, 12/125 (9.6%) patients developed ICH. Neither the primary tumor site nor the number of brain metastases was associated with the development of ICH. ICH incidence was not associated with the use of anticoagulant therapy, with 8/67 (11.94%) patients on outpatient anticoagulation and 4/58 (6.9%) not on anticoagulation experiencing ICH (p = 0.33). The type of treatment did not significantly influence ICH, although those having combined WBRT and SRS were numerically more likely to experience ICH (4/15; 26.67%) of this cohort. In patients on enoxaparin, there was no difference in the incidence of ICH for daily versus twice-daily dosing (p = 1.0). Long-term anticoagulant use is not associated with an increased incidence of ICH in patients with intracranial metastases.

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Authors and Affiliations

  1. Internal Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA

    Heidi Horstman

  2. Radiation Oncology Program, University of Utah, 1950 Circle of Hope, Rm. 1570, Salt Lake City, UT, 84112, USA

    Joshua Gruhl

  3. Department of Biostatistics, College of Public Health, 984375 Nebraska Medical Center, Omaha, NE, 68198-4375, USA

    Lynette Smith

  4. Division of Oncology and Hematology, 986840 Nebraska Medical Center, Omaha, NE, 68198-6840, USA

    Apar K. Ganti & Nicole A. Shonka

Authors
  1. Heidi Horstman
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  2. Joshua Gruhl
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  3. Lynette Smith
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  4. Apar K. Ganti
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  5. Nicole A. Shonka
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Authors’ contribution

AG and NS helped in project conception. JG, HH, and NS collected the data. AG, JG, HH, LS, and NS prepared and edited the MS. LS contributed to statistical preparation.

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Correspondence to Nicole A. Shonka.

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The authors declare that they have no competing interests.

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Horstman, H., Gruhl, J., Smith, L. et al. Safety of long-term anticoagulation in patients with brain metastases. Med Oncol 35, 43 (2018). https://doi.org/10.1007/s12032-018-1101-z

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  • DOI: https://doi.org/10.1007/s12032-018-1101-z

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