In a single-institution retrospective cohort study reported in Neuro-Oncology, Reed-Guy et al found that direct oral anticoagulant therapy was associated with a reduced risk of clinically relevant intracranial hemorrhage vs low–molecular-weight heparin in patients with glioblastoma diagnosed with venous thromboembolism (VTE).
Study Details
The study involved patients with glioblastoma diagnosed with VTE between 2014 and 2021 at the Hospital of the University of Pennsylvania who were treated with a direct oral anticoagulant or low–molecular-weight heparin. The primary outcome measure was clinically relevant intracranial hemorrhage within the first 30 days of anticoagulation, defined as any intracranial hemorrhage that was fatal, symptomatic, required surgical intervention, or led to cessation of anticoagulation.
Key Findings
A total of 121 patients were identified for 30-day intracranial hemorrhage analysis, consisting of 33 in the direct oral anticoagulant group and 88 in the low–molecular-weight heparin group. The incidence of clinically relevant intracranial hemorrhage at 30 days was 0% in the direct oral anticoagulant group vs 9.1% in the low–molecular-weight heparin group (P = .11). The incidence of fatal intracranial hemorrhage was 0% in the direct oral anticoagulant group vs 2.3% in the low–molecular-weight heparin group (P = 1.0). The cumulative incidence of bleeding (including intracranial hemorrhage of any severity, gastrointestinal bleeding, and any other bleeds requiring medical attention) was 3.0% vs 19.3% (P = .024).
The 6-month analysis included 32 patients receiving direct oral anticoagulants and 75 receiving low–molecular-weight heparin maintained on their initial anticoagulant. The cumulative incidence of clinically relevant intracranial hemorrhage at 6 months was 0% in the direct oral anticoagulant group vs 24% in the low–molecular-weight heparin group (P = .001). The cumulative incidence of fatal intracranial hemorrhage was 0% vs 5.3% (P = .32). The cumulative incidence of any bleeding was 9.4% vs 41.3% (P = .001).
The investigators concluded: “Direct oral anticoagulants are associated with a lower incidence of clinically relevant intracranial hemorrhage in patients with glioblastoma-associated VTE compared to low–molecular-weight heparin.”
Stephen J. Bagley, MD, MSCE, of the Perelman Center for Advanced Medicine, Perelman School of Medicine, University of Pennsylvania, is the corresponding author of the Neuro-Oncology article.
Disclosure: The investigators reported there was no external funding for the study. For full disclosures of the study authors, visit academic.oup.com.
