title: Successful administration of a low dose of calcium nadroparin in patients suffering from pulmonary embolism and brain metastases: a report of two cases.
abstract: OBJECTIVE
  To focus on the optimal management of thromboembolic complication in patients who have undergone chemotherapy with concomitant brain metastases and referred to a Division of Clinical Oncology.
  
  
  BACKGROUND
  Thromboembolic diseases are common events in cancer patients due to clotting activation by tumor cells. On the other hand, brain metastases are common complication of systemic cancers. Postmortem studies show that a quarter of patients dying from cancer have intracranial metastases. Brain metastases and pulmonary embolism are life-threatening conditions because of the risk of fatal endocranic hypertension and severe dyspnea. Calcium nadroparin is a low molecular weight heparin usually administered in patient with venous thromboembolism at a dose level of 180 IU/kg/daily.
  
  
  METHODS
  The authors report the cases of two patients with intracranial metastases and pulmonary embolism-related dyspnea successfully treated with low dose of calcium nadroparin. A patient suffering from metastatic breast cancer and another one with metastatic nonsmall cell lung cancer were recently referred to our department because of severe dyspnea occurring during chemotherapy treatment. Both patients had cerebellar intracranial metastases. Massive pulmonary embolisms were shown by means of the computerized tomography. Despite the administration of a lower heparin dose than the usual one, around three-quarters of the calcium nadroparin daily conventional dose, quickly regressed dyspnea. Significant pulmonary embolism regression was revealed with computerized tomography scan within 8 weeks from the beginning of the thromboembolic complications. None of the patients showed any heparin treatment-related complications.
  
  
  CONCLUSIONS
  The authors conclude that, with regard to cancer patients carrying brain metastases who require anti-coagulant therapy, increased risk of intracranial hemorrhage should be kept in mind. An initial low molecular weight heparin dose reduction could be effective, and safely administered, also in case of pulmonary embolism with severe dyspnea.
authors.affiliation: Division of Medical Oncology, "San Vincenzo" Hospital, Taormina, Italy. f.vitale@videobank.it
authors.forename: Felice Vito
authors.initials: FV
authors.lastname: Vitale
authors.forename: Stefano
authors.initials: S
authors.lastname: Rotondo
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sessa
authors.forename: Giovanna
authors.initials: G
authors.lastname: Antonelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Colina
authors.forename: Alessandra
authors.initials: A
authors.lastname: Parisi
authors.forename: Valentina
authors.initials: V
authors.lastname: Giamo
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferraù
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000503:physiopathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000503:physiopathology / Q000556:secondary; D002528:Cerebellar Neoplasms / Q000503:physiopathology* / Q000556:secondary; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D017762:Nadroparin