QL-15 * A RETROSPECTIVE ANALYSIS OF INTRACRANIAL HEMORRHAGE IN PATIENTS RECEIVING ANTICOAGULATION FOR VENOUS THROMBOEMBOLISM IN THE SETTING OF GLIOBLASTOMA

Abstract

BACKGROUND: Venous thromboembolism (VTE) is a complication of glioblastoma. Anticoagulating patients with glioblastoma carries a theoretical risk of intracranial hemorrhage (ICH). METHODS: We performed a retrospective review of consecutive glioblastoma patients (2007-2013) diagnosed with VTE, with documentation of historical, clinical, and radiologic findings. RESULTS: 173 (33%) of 523 glioblastoma patients had VTE events. Seventeen (9.8%) had ICH: 6 (35%) subdural hematomas and 11 (65%) intratumoral hemorrhage. Enhancement in the area of subsequent intratumoral hemorrhage was noted in 9 of 10 with available pre-ICH scans. Multivariable regression did not show associations between ICH and tumor enhancement diameter or VEGF-inhibitor use. Fifteen (16%) patients receiving anticoagulation had ICH compared to 2 (2.6%) not receiving anticoagulation (p = 0.005). The type of anticoagulant used was not associated with development of ICH. Median survival from VTE diagnosis to death was 7.2 months in ICH group, compared to 6.2 months in non-ICH individuals (p = 0.4). Median survival from VTE diagnosis to death were 7.9 and 4.7 months (p = 0.07) in patients receiving anticoagulation and those not on anticoagulation, respectively; percentage of patients with KPS scores > 70 was not statistically significant between the groups (p = 0.14). Of fifty-one patients with perioperative VTEs, 38 (74%) were not treated with anticoagulation, while 13 (26%) did receive anticoagulation post-VTE diagnosis (p < 0.0001). CONCLUSION: Patients with glioblastoma and VTE on anticoagulation have increased incidence of ICH. However, ICH was not associated with lower median survival from time of VTE. Additionally, patients receiving anticoagulation trended towards longer survival from time of VTE. Intratumoral hemorrhage typically occurs within the enhancing portion of tumor; however, no relationship was identified between the development of ICH and (i) the diameter of enhancement or (ii) type of anticoagulant used. It is appropriate to initiate anticoagulation in glioblastoma patients with VTEs and, in the case of peri-operative VTEs, start anticoagulation during post-operative outpatient visits.