Article
Direct oral anticoagulants vs. low-molecular-weight heparin for pulmonary embolism in glioblastoma
Direkte orale Antikoagulantien vs. niedermolekulares Heparin zur Behandlung der Lungenembolie im Glioblastom
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Published: | June 4, 2021 |
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Objective: Glioblastoma (GBM) is a cancer type with high thrombogenic potential and GBM patients are therefore at a particularly high risk for thrombotic events. To date only limited data on anticoagulation management after pulmonary embolism (PE) in GBM is available and the use of DOACs remain off-labe.l
Methods: A retrospective comparative cohort analysis of patients with GBM and postoperative, thoracic CT-scan confirmed, PE was performed. Clinical course, follow-up at 6 and 12 months and overall survival (OS) were evaluated using medical charts and neuroradiological data.
Results: Out of 584 GBM patients, 8% suffered from postoperative PE. Out of theses, 30% received DOACs and 70% LMWH for therapeutic anticoagulation. There was no significant difference in major intracranial hemorrhage (ICH), re-thrombosis or re-embolism between the two cohorts. Although statistically non-significant, a tendency to reduced mRS at 6- and 12- months was observed in the LMWH cohort. Furthermore, patients receiving DOACs had a statistical benefit in OS.
Conclusion: In our analysis DOACs showed a favourable safety profile in terms of major ICH, re-thrombosis and re-embolism in GBM patients with postoperative PE. Prospective, randomized trials are urgent to evaluate DOACs for therapeutic anticoagulation in GBM patients with PE.