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.
Resumen
Patients with central nervous system (CNS) malignancies have a substantial risk for developing both thrombotic and bleeding disorders.
Por qué esto importa para la hirudoterapia
Este artículo analiza el manejo terapéutico de los trastornos hemorrágicos y trombóticos que complican las neoplasias del sistema nervioso central, centrándose en la profilaxis y el tratamiento del tromboembolismo venoso. Aboga por la heparina de bajo peso molecular en lugar de la warfarina oral para la TEV en pacientes con neoplasia del SNC, junto con métodos de profilaxis mecánica, dada la preocupación por la hemorragia intracraneal. La revisión no aborda la hirudoterapia, las sanguijuelas ni los anticoagulantes derivados de sanguijuela. Para el ámbito de la ASH, la relevancia se limita a proporcionar contexto clínico para la anticoagulación en una población con alto riesgo trombótico en la que el riesgo de sangrado está elevado—un área en la que no se aborda la terapia con sanguijuelas. No se menciona ningún agente ni concepto relacionado con la sanguijuela, por lo que la conexión con la hirudoterapia es negligible; el artículo trata principalmente sobre la anticoagulación farmacológica convencional en neurooncología.
Citación
The therapeutic management of bleeding and thrombotic disorders complicating CNS malignancies
Strowd RE et al. · Current treatment options in oncology, 2012
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026