Venous thromboembolism (VTE) is common in cancer patients with brain metastases but therapeutic anticoagulation does not increase the risk for intracranial hemorrhage, according to new data.
In a matched, retrospective cohort study of 293 cancer patients with brain metastases (104 treated with therapeutic enoxaparin and 189 controls), there were no differences at 1 year between the two groups for measurable (19% vs 21%; Gray test, P = .97; hazard ratio, 1.02; 90% confidence interval [CI], 0.66-1.59), significant (21% vs 22%; P = .87), and total (44% vs 37%; P = .13) intracranial hemorrhages.
“Reassuringly, the cumulative incidence of intracranial hemorrhage was not significantly different in those patients who received therapeutic enoxaparin compared with controls for all outcomes including measurable, total, and significant intracranial hemorrhages,” wrote Dr. Jessica Donato of Harvard Medical School, Boston, and colleagues (Blood 2015 Jul 23 doi:10.1182/blood-2015-02-626788).
The only covariate that was predictive of hemorrhage in this study was the combined group of renal cell carcinoma and melanoma, as the risk for intracranial hemorrhage was fourfold higher (adjusted hazard ratio, 3.98; 90% CI, 2.41-6.57; P less than .001) in those subgroups.
In an accompanying commentary in the same issue of Blood, Dr. Lisa Baumann Kreuziger of Medical College of Wisconsin, Milwaukee, wrote that although the study was well designed, “its retrospective nature creates inherent limitations.”
As an example, besides tumor type, the multivariable analysis did not identify other clinical factors that could guide clinicians when assessing the risk of intracranial hemorrhage, she wrote (Blood 2015 Jul 23. doi: 10.1182/blood-2015-06-648089]).
But in spite of the limitations, the study “further supports the statement from the 2014 American Society of Clinical Oncology Guidelines that brain metastases are not a contraindication to treatment of VTE with low-molecular-weight heparin,” she concluded.