Medical Oncology

, 35:43 | Cite as

Safety of long-term anticoagulation in patients with brain metastases

  • Heidi Horstman
  • Joshua Gruhl
  • Lynette Smith
  • Apar K. Ganti
  • Nicole A. Shonka
Original Paper


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.


Brain metastases Anticoagulation Intracranial hemorrhage Intratumoral hemorrhage Outpatient anticoagulation 


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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Internal MedicineMaine Medical CenterPortlandUSA
  2. 2.Radiation Oncology ProgramUniversity of UtahSalt Lake CityUSA
  3. 3.Department of Biostatistics, College of Public Health984375 Nebraska Medical CenterOmahaUSA
  4. 4.Division of Oncology and Hematology986840 Nebraska Medical CenterOmahaUSA

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