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Management of Venous Thromboembolism in Patients With Primary and Metastatic Brain Tumors

From the Departments of Oncology, Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD

Address reprint requests to Michael B. Streiff, MD, Division of Hematology, The Johns Hopkins University School of Medicine, 1830 E Monument St, Suite 7300, Baltimore, MD 21205; e-mail: mstreif{at}jhmi.edu

Venous thromboembolism occurs commonly throughout the clinical course of patients with brain tumors. A number of hemostatic and clinical factors contribute to this hypercoagulable state. Concern over the possibility of intracranial bleeding has limited the use of anticoagulation in this population. However, mechanical approaches such as vena cava filters have high complication and treatment failure rates in patients with intracranial malignancies. In addition, the available data suggest that anticoagulation can be used safely and effectively in most of these patients. Patients with thrombocytopenia, recent neurosurgery, and tumor types prone to bleeding require special consideration. When intracranial hemorrhage does occur, it is often due to overanticoagulation, requiring prompt anticoagulation reversal and neurosurgical consultation.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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