Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases: A case series study

Felice Vito Vitale, Stefano Rotondo, Edoardo Sessa, Alessandra Parisi, Valentina Giaimo, Alessandro D'Angelo, Giovanna Antonelli, Placido Romeo, Francesco Ferraù

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background. Venous thromboembolism (VTE) and brain metastases (MTS) are significant clinical problems in the cancer patient population. Brain MTS and deep vein thrombosis are life-threatening conditions because of the risk of fatal endocranic hypertension and pulmonary embolism. Low molecular weight heparin (LMWH) is a major treatment for cancer patients suffering from VTE with regard to the management of the acute phase and subsequent secondary prophylaxis. Treatment with anticoagulants is feared because of the risk of triggering a massive intracranial hemorrhage.Methods. The medical records of patients with hypercoagulability-related complications and carrying brain MTS treated with LMWH, in a 10-year period, were scrutinized. The authors aimed to focus on the occurrence of intracranial hemorrhage in anticoagulated patients; furthermore, data were collected with regard to the characteristics of the administered LMWHs along with the duration and dosing of the anticoagulative treatment.Results. A total of 38 patients (pts) carrying an intracranial metastatic tumor were administered LMWHs: calcium nadroparin (32 pts); enoxaparin (2 pts); reviparin (2 pts); parnaparin (2 pts). Reason for LMWH therapy: deep vein thrombosis and/or pulmonary embolism (15 pts); superficial thrombophlebitis (15 pts); intracardiac thrombus (1 pt); mild DIC (5 pts); acute DIC (1 pt); Raynaud phenomenon (1 pt); atrial fibrillation (1 pt). Median duration of LMWH therapy: 13 weeks (range 1-52). None of the patients developed clinical and/or radiographic findings imputable to intracranial hemorrhage.Conclusion. There is no standard medical approach for the management of patients who require anticoagulant treatment and are suffering from brain MTS. These patients as necessary, might be anticoagulated with LMWH and its dose reduction is to be considered.

Original languageEnglish
Pages (from-to)10-16
Number of pages7
JournalJournal of Oncology Pharmacy Practice
Volume18
Issue number1
DOIs
Publication statusPublished - Mar 2012

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Thrombophilia
Low Molecular Weight Heparin
Neoplasm Metastasis
Brain
Neoplasms
Intracranial Hemorrhages
Dacarbazine
Venous Thromboembolism
Pulmonary Embolism
Venous Thrombosis
Anticoagulants
Therapeutics
Nadroparin
Enoxaparin
Thrombophlebitis
Raynaud Disease
Atrial Fibrillation
Medical Records

Keywords

  • brain metastases
  • cancer
  • intracranial hemorrhage
  • Low molecular weight heparin
  • thromboembolism

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Oncology

Cite this

Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases : A case series study. / Vitale, Felice Vito; Rotondo, Stefano; Sessa, Edoardo; Parisi, Alessandra; Giaimo, Valentina; D'Angelo, Alessandro; Antonelli, Giovanna; Romeo, Placido; Ferraù, Francesco.

In: Journal of Oncology Pharmacy Practice, Vol. 18, No. 1, 03.2012, p. 10-16.

Research output: Contribution to journalArticle

Vitale, Felice Vito ; Rotondo, Stefano ; Sessa, Edoardo ; Parisi, Alessandra ; Giaimo, Valentina ; D'Angelo, Alessandro ; Antonelli, Giovanna ; Romeo, Placido ; Ferraù, Francesco. / Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases : A case series study. In: Journal of Oncology Pharmacy Practice. 2012 ; Vol. 18, No. 1. pp. 10-16.
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T1 - Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases

T2 - A case series study

AU - Vitale, Felice Vito

AU - Rotondo, Stefano

AU - Sessa, Edoardo

AU - Parisi, Alessandra

AU - Giaimo, Valentina

AU - D'Angelo, Alessandro

AU - Antonelli, Giovanna

AU - Romeo, Placido

AU - Ferraù, Francesco

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N2 - Background. Venous thromboembolism (VTE) and brain metastases (MTS) are significant clinical problems in the cancer patient population. Brain MTS and deep vein thrombosis are life-threatening conditions because of the risk of fatal endocranic hypertension and pulmonary embolism. Low molecular weight heparin (LMWH) is a major treatment for cancer patients suffering from VTE with regard to the management of the acute phase and subsequent secondary prophylaxis. Treatment with anticoagulants is feared because of the risk of triggering a massive intracranial hemorrhage.Methods. The medical records of patients with hypercoagulability-related complications and carrying brain MTS treated with LMWH, in a 10-year period, were scrutinized. The authors aimed to focus on the occurrence of intracranial hemorrhage in anticoagulated patients; furthermore, data were collected with regard to the characteristics of the administered LMWHs along with the duration and dosing of the anticoagulative treatment.Results. A total of 38 patients (pts) carrying an intracranial metastatic tumor were administered LMWHs: calcium nadroparin (32 pts); enoxaparin (2 pts); reviparin (2 pts); parnaparin (2 pts). Reason for LMWH therapy: deep vein thrombosis and/or pulmonary embolism (15 pts); superficial thrombophlebitis (15 pts); intracardiac thrombus (1 pt); mild DIC (5 pts); acute DIC (1 pt); Raynaud phenomenon (1 pt); atrial fibrillation (1 pt). Median duration of LMWH therapy: 13 weeks (range 1-52). None of the patients developed clinical and/or radiographic findings imputable to intracranial hemorrhage.Conclusion. There is no standard medical approach for the management of patients who require anticoagulant treatment and are suffering from brain MTS. These patients as necessary, might be anticoagulated with LMWH and its dose reduction is to be considered.

AB - Background. Venous thromboembolism (VTE) and brain metastases (MTS) are significant clinical problems in the cancer patient population. Brain MTS and deep vein thrombosis are life-threatening conditions because of the risk of fatal endocranic hypertension and pulmonary embolism. Low molecular weight heparin (LMWH) is a major treatment for cancer patients suffering from VTE with regard to the management of the acute phase and subsequent secondary prophylaxis. Treatment with anticoagulants is feared because of the risk of triggering a massive intracranial hemorrhage.Methods. The medical records of patients with hypercoagulability-related complications and carrying brain MTS treated with LMWH, in a 10-year period, were scrutinized. The authors aimed to focus on the occurrence of intracranial hemorrhage in anticoagulated patients; furthermore, data were collected with regard to the characteristics of the administered LMWHs along with the duration and dosing of the anticoagulative treatment.Results. A total of 38 patients (pts) carrying an intracranial metastatic tumor were administered LMWHs: calcium nadroparin (32 pts); enoxaparin (2 pts); reviparin (2 pts); parnaparin (2 pts). Reason for LMWH therapy: deep vein thrombosis and/or pulmonary embolism (15 pts); superficial thrombophlebitis (15 pts); intracardiac thrombus (1 pt); mild DIC (5 pts); acute DIC (1 pt); Raynaud phenomenon (1 pt); atrial fibrillation (1 pt). Median duration of LMWH therapy: 13 weeks (range 1-52). None of the patients developed clinical and/or radiographic findings imputable to intracranial hemorrhage.Conclusion. There is no standard medical approach for the management of patients who require anticoagulant treatment and are suffering from brain MTS. These patients as necessary, might be anticoagulated with LMWH and its dose reduction is to be considered.

KW - brain metastases

KW - cancer

KW - intracranial hemorrhage

KW - Low molecular weight heparin

KW - thromboembolism

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