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 (2020). A review of anticoagulation in patients with central nervous system malignancy: between a rock and a hard place. (In Press). Journal of neurology Springer-Medizin-Verlag 10.1007/s00415-020-09775-7

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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.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Seiffge, David Julian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0340-5354

Publisher:

Springer-Medizin-Verlag

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

14 Jul 2020 16:30

Last Modified:

07 Aug 2020 06:30

Publisher DOI:

10.1007/s00415-020-09775-7

PubMed ID:

32124043

Uncontrolled Keywords:

Anticoagulation Cancer Direct oral anticoagulant Intracranial haemorrhage

BORIS DOI:

10.7892/boris.145149

URI:

https://boris.unibe.ch/id/eprint/145149

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