Background: Cancer patients have an increased risk of venous thromboembolism (VTE). Patients with glioblastoma multiforme (GBM) are at higher risk compared to other cancers1. VTE risk in GBM has been reported to be as high as 28% per annum (1.5 – 2.0% per month)1. Long term thromboprophylaxis for cancer patients is being explored2; however, is not currently supported in GBM1,2. VTE treatment with low-molecular weight heparin (LMWH) remains the standard of care given a lack of evidence for direct-acting anticoagulants (DOAC) in this population, despite the convenience of DOAC administration.
Aim:
To document rates of VTE in GBM patients in a single-institution.
Method:
VTEs in patients with GBM were retrospectively identified by cross-matching coding data from Medical Imaging and inpatient medical record for all l GBM cases between 1/1/14- 31/12/17.
Results:
Fourteen of 65 (21.5%) of GBM patients were diagnosed with VTE. The majority were in ambulatory patients. Five episodes (33%) occurred in inpatients none of whom were receiving thromboprophylaxis. Five were managed with a DOAC (rivaroxaban), and seven with therapeutic enoxaparin (1mg/kg BD). There were no episodes of grade 3 or 4 bleeding or recurrent VTEs .
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Characteristic |
VTE n (%) |
No VTE n(%) |
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Sex Male 55 Female 20 |
12 (21.8) 2 (10.0) |
33 (78.2) 18 (90.0) |
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Median age, years (range) |
61 (38-78) |
54 (17-79) |
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Setting |
Inpatient n (%) |
Ambulatory n (%) |
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Episodes of VTE (14) |
5 (35.7) |
9 (64.3) |
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|
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Management |
Enoxaparin n (%) |
Rivaroxaban n (%) |
Unknown n (%) |
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Episodes of VTE (14 ) |
7 (50.0) |
5 (35.71) |
2 (16.7) |
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Conclusions:
VTE is common in GBM, even in an ambulatory population. Prospective research to assess the risk-benefit ratio of primary pharmacological thromboprophylaxis in this population is needed. Investigation into the safety and efficacy of DOACs for both prevention and treatment in this population is also warranted.