A review of anticoagulation in patients with central nervous system malignancy: between a rock and a hard place.

Swan, Dawn; Seiffge, David Julian; Thachil, Jecko (2021). A review of anticoagulation in patients with central nervous system malignancy: between a rock and a hard place. Journal of neurology, 268(7), pp. 2390-2401. Springer-Medizin-Verlag 10.1007/s00415-020-09775-7

Text Swan, 2020, A review of anticoagulation.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (617kB)

The incidence and prevalence of patients who develop primary and secondary metastatic central nervous system cancer (CNS) is increasing. This is a consequence of advancements in the sensitivity and availability of diagnostic imaging, and improved therapeutic options, leading to increased detection of CNS malignancies and improved survival. These patients are at very high risk of thrombosis as well as haemorrhage, and the optimum management of anticoagulation can be challenging for treating clinicians, particularly as robust prospective evidence is sparse. In this focused review, we discuss (1) risk factors for thrombosis and bleeding in these patients, (2) management of acute venous thromboembolism (VTE) including evidence for direct oral anticoagulants, and how to approach patients with contraindications to anticoagulation, (3) ambulatory VTE prophylaxis, (4) VTE prophylaxis in patients who have undergone craniotomy for cancer, and (5) management of anticoagulation-related intracranial haemorrhage. Based on review of the available literature and author opinion, we propose practical management algorithms to aid clinicians faced with treating CNS cancer patients with thrombosis or CNS haemorrhage.

Interest & Impact

Downloads

0 since deposited on 14 Jul 2020
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item