The therapeutic management of bleeding and thrombotic disorders complicating CNS malignancies
Research article published in Current treatment options in oncology (2012)
Abstract
Patients with central nervous system (CNS) malignancies have a substantial risk for developing both thrombotic and bleeding disorders. The risk of venous thromboembolism (VTE) is substantially higher in these patients, both in the perioperative period and throughout their disease course. Patients with CNS malignancy harbor a latent hypercoagulability, which predisposes to VTE, as do postoperative immobility, hemiparesis, and other factors. The management of VTE in these patients is complex, given the significant morbidity and mortality associated with intratumoral hemorrhage. In the past, the perceived risk of intracranial hemorrhage limited the use of anticoagulation for the management of VTE with many favoring nonpharmacologic methods for prophylaxis and treatment. Inferior vena cava (IVC) filters have since lost favor at many centers given significant complications, which appear to be more frequent in patients with CNS malignancy. Recent studies have demonstrated safe and efficacious use of anticoagulation in these patients with a low incidence of intracranial hemorrhage. Treatment of established VTE is now recommended in this population with many centers favoring low-molecular-weight heparin (LMWH) versus oral warfarin for short- or long-term treatment. We advocate a multimodality approach utilizing compression stockings, intermittent compression devices, and heparin in the perioperative setting as the best proven method to reduce the risk of VTE. In the absence of a strict contraindication to systemic anticoagulation, such as previous intracranial hemorrhage or profound thrombocytopenia, we recommend LMWH in patients with newly diagnosed VTE and a CNS malignancy.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Patients with central nervous system (CNS) malignancies have a substantial risk for developing both thrombotic and bleeding disorders.
Warum dies für die Hirudotherapie relevant ist
This article discusses the therapeutic management of bleeding and thrombotic disorders complicating central nervous system malignancies, focusing on venous thromboembolism prophylaxis and treatment. It advocates low-molecular-weight heparin over oral warfarin for VTE in patients with CNS malignancy, alongside mechanical prophylaxis methods, given concerns about intracranial hemorrhage. The review does not discuss hirudotherapy, leeches, or leech-derived anticoagulants. For ASH's domain, the relevance is limited to providing clinical context for anticoagulation in a high-risk thrombotic population where bleeding risk is elevated—an area where leech therapy is not addressed. No leech-related agent or concept is mentioned, so the connection to hirudotherapy is negligible; the article is primarily about conventional pharmacologic anticoagulation in neuro-oncology.
Zitation
The therapeutic management of bleeding and thrombotic disorders complicating CNS malignancies
Strowd RE et al. · Current treatment options in oncology, 2012
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