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Lung Cancer • Breast Cancer • Radiation Oncology • Neuro-Oncology • Melanoma/Skin Cancer • Medical Oncology • Brain Metastases
How do you manage anticoagulation for patients with DVT/PE who have brain metastases?
Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage. Is there any data to support this? In your field, e.g. melanoma, NSCLC, breast, are there specific considerations to take into account? Would radiation treatments (either SRS or WBRT) be an indication to hold anticoagulation?
Answer from: Radiation Oncologist at Academic Institution
This issue is not infrequent. The data is scarce, which is a concern to me about publication bias especially for a condition that many patients do not live longer than 6 months and that data for ICH risk for anticoagulants without brain metastases is not zero. Do we really know the cause of death?
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Answer from: Medical Oncologist at Academic Institution
As a general rule, there is no need to hold anticoagulation in patients with brain metastases. A number of retrospective studies and at least one meta-analysis demonstrated that there is no increased risk of intracranial hemorrhage with anticoagulation. The most recent study was a matched cohort st...
Answer from: Radiation Oncologist at Academic Institution
Not all brain metastases pose the same risk to patients. Rapid, numerous (even if tiny), new onset metastases from RCC or melanoma (especially BRAF mutant) can go from asymptomatic to life threatening hemorrhage within 1-2 weeks and I would strongly caution anti-coagulation in these patients. If t...