Risk of intracranial bleeding in patients with primary brain cancer receiving therapeutic anticoagulation for venous thromboembolism: A meta‐analysis

Brain and Behavior - Tập 10 Số 6 - 2020
Angelo Porfidia1, Marzia Giordano2, Carmelo Lucio Sturiale3, Sonia D’Arrigo4, Paolo Prandoni5, Alessandro Olivi6, Walter Ageno5, Roberto Pola2
1Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
2Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
3Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
4Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
5Department of Medicine and Surgery, Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
6Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

Tóm tắt

AbstractIntroductionVenous thromboembolism (VTE) is common in glioma patients. Also, spontaneous intracerebral hemorrhage (ICH) is frequently observed in subjects with primary brain tumors. Thus, the management of anticoagulant therapy for VTE is challenging and controversial in these patients. We performed a meta‐analysis to clarify the risk of ICH in glioma patients treated with anticoagulant therapy for VTE compared to glioma patients without VTE.Materials and MethodsA systematic search of the literature was conducted using PubMed, Scopus, and EMBASE databases between January 1980 and January 2019 without language restrictions. Summary statistics for ICH were obtained by calculating the odds ratio (OR) using a random effects model, and heterogeneity across studies was estimated by the I2 statistic. The Newcastle–Ottawa Scale was used to evaluate the quality of studies.ResultsA total of 368 studies were initially identified. Of these, 346 were excluded after title review. The remaining 22 studies were reviewed in detail. According to the PICO criteria, 15 studies were excluded. Finally, 7 studies were included in the meta‐analysis. The OR for ICH in glioma patients receiving therapeutic anticoagulation for VTE versus those who did not receive anticoagulation was 3.66 (95% confidence interval [CI], 1.84–7.29; I2 = 31%).ConclusionsThis meta‐analysis demonstrates that anticoagulation for VTE increases the risk of ICH in subjects with malignant brain tumors. Future studies are warranted to fully understand the best medical treatment of VTE in glioma patients.

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Brain and Behavior

Tập 10 Số 6

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