Practical guidance for direct oral anticoagulant use in the treatment of venous thromboembolism in primary and metastatic brain tumor patients

Author:

Ranjan Surabhi1ORCID,Leung Denise2ORCID,Ghiaseddin Ashley P.3,Taylor Jennie W.4,Lobbous Mina5,Dhawan Andrew5,Budhu Joshua A.6,Coffee Elizabeth6ORCID,Melnick Kaitlyn3,Chowdhary Sajeel A.7,Lu‐Emerson Christine8,Kurz Sylvia C.9,Burke Joy E.10,Lam Keng11,Patel Mallika P.12,Dunbar Erin M.13,Mohile Nimish A.14,Peters Katherine B.12

Affiliation:

1. Department of Neurology Cleveland Clinic Florida Weston Florida USA

2. Department of Neurology University of Michigan Ann Arbor Michigan USA

3. Department of Neurosurgery University of Florida Gainesville Florida USA

4. Department of Neurology University of California San Francisco California USA

5. Rose Ella Burkhardt Brain Tumor & Neuro‐Oncology Center Cleveland Clinic Foundation Cleveland Ohio USA

6. Department of Neurology Memorial Sloan Kettering Cancer Center New York New York USA

7. Tampa General Hospital Cancer Institute Tampa General Hospital Tampa Florida USA

8. Department of Neurology Maine Medical Center and Maine Health Cancer Care Portland Maine USA

9. Department of Neurology & Interdisciplinary Neuro‐Oncology Hertie Institute for Clinical Brain Research Eberhard Karls University Tübingen Tübingen Germany

10. Department of Neurology Beth Israel Lahey Health Lahey Hospital and Medical Center Burlington Massachusetts USA

11. Department of Neuro‐Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA

12. Preston Robert Tisch Brain Tumor Center Duke University Durham North Carolina USA

13. Piedmont Brain Tumor Center Atlanta Georgia USA

14. Department of Neurology University of Rochester Rochester New York USA

Abstract

AbstractManagement of venous thromboembolism (VTE) in patients with primary and metastatic brain tumors (BT) is challenging because of the risk of intracranial hemorrhage (ICH). There are no prospective clinical trials evaluating safety and efficacy of direct oral anticoagulants (DOACs), specifically in patients with BT, but they are widely used for VTE in this population. A group of neuro‐oncology experts convened to provide practical clinical guidance for the off‐label use of DOACs in treating VTE in patients with BT. We searched PubMed for the following terms: BTs, glioma, glioblastoma (GBM), brain metastasis, VTE, heparin, low‐molecular‐weight heparin (LWMH), DOACs, and ICH. Although prospective clinical trials are needed, the recommendations presented aim to assist clinicians in making informed decisions regarding DOACs for VTE in patients with BT.

Publisher

Wiley

Subject

Cancer Research,Oncology

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