title: Risk of intracranial hemorrhage with anticoagulation therapy in melanoma patients with brain metastases.
abstract: Venous thromboembolism (VTE) is a frequent complication in melanoma patients with brain metastases (BM). The management of these patients is challenging because of the high risk of intracranial hemorrhage (ICH) and the limited data available on the safety of anticoagulation in this scenario. We reviewed the treatments and outcomes among melanoma patients with BM and VTE at our institution to determine the safety of anticoagulation in these patients. A retrospective chart review was performed to identify melanoma patients with BM who were diagnosed with VTE. The clinical characteristics of the BM and the VTE, the treatments given for VTE, subsequent ICH, and overall survival (OS) were determined. The characteristics and outcomes were compared between patients who received systemic anticoagulation and those who did not. A total of 74 evaluable melanoma patients with BM and VTE were identified. Fifty-seven (77%) patients received systemic anticoagulation. There was no significant difference in the number (P=0.40) or the maximum diameter (P=0.55) of brain metastasis between the patients who received anticoagulation and those who did not. Two (4%) patients who received anticoagulation developed ICH, which was not statistically different from the patients who did not receive anticoagulation (0%, P=1.00). There was a trend toward longer OS from VTE among patients who received systemic anticoagulation (median OS: 4.2 vs. 1.2 months, P=0.06). Anticoagulation for VTE did not significantly increase the risk of ICH or decrease OS in patients with melanoma BM. These data support the safety of systemic anticoagulation for VTE in these patients.
authors.affiliation: Department of Melanoma Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas 77054, USA.
authors.forename: Gladys
authors.initials: G
authors.lastname: Alvarado
authors.forename: Rahat
authors.initials: R
authors.lastname: Noor
authors.forename: Roland
authors.initials: R
authors.lastname: Bassett
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Papadopoulos
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Kim
authors.forename: Wen-Jen
authors.initials: WJ
authors.lastname: Hwu
authors.forename: Agop
authors.initials: A
authors.lastname: Bedikian
authors.forename: Sapna
authors.initials: S
authors.lastname: Patel
authors.forename: Patrick
authors.initials: P
authors.lastname: Hwu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Davies
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications* / Q000556:secondary; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced*; D008545:Melanoma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms; D016019:Survival Analysis; D054556:Venous Thromboembolism / Q000150:complications* / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants