title: Recurrent venous thromboembolism in glioblastoma.
abstract: BACKGROUND
  Patients with glioblastoma (GBM) are at increased risk of initial and recurrent venous thromboembolism (VTE) but rates of recurrence and real-world treatment choices are incompletely understood.
  
  
  OBJECTIVE
  We aim to describe the treatment of incident VTE, report incidence and risk factors for recurrence.
  
  
  METHODS
  We conducted a retrospective cohort study of consecutive Cleveland Clinic patients with GBM presenting with objectively diagnosed deep vein thrombosis (DVT) or pulmonary embolism (PE) from 2007 to 2013 with at least 6-month follow-up. We collected information on patient demographics, VTE incidence, treatment and recurrence. Data were analyzed using multivariate logistic regression analysis.
  
  
  RESULTS
  Of 450 patients with GBM, 145 (32.2%) developed VTE and comprised the study population. Of these, 11 (7.6%) experienced PE, 117 (80.7%) had DVT and 16 (11%) had DVT as well as PE. Fifty five (37.9%) VTE events occurred in the first 30 post-operative days and 56 (38.6%) during chemotherapy. Thirty one (21.4%) patients were untreated. Treatments included enoxaparin (N=36, 24.8%), warfarin (15, 10.3%) or vena cava filters either alone (N=39, 26.9%) or in combination with anticoagulation (N=21, 14.5%). Recurrent VTE occurred in 39 patients (26.9%).In multivariate analysis, lack of long term anticoagulation (HR 11.2, CI 1.5-86.3, p<0.05) and the presence of second primary malignancy (HR 3.69, CI 1.2-11.1, p<0.05) were significantly associated with recurrent VTE.
  
  
  CONCLUSIONS
  VTE and recurrent VTE are highly prevalent throughout the disease course among patients with GBM. Long term anticoagulation is associated with reduced risk of recurrent VTE but is often not utilized.
authors.affiliation: Division of Hematology and Medical Oncology, Washington University in St Louis School of Medicine, 660 S Euclid Avenue, Campus Box 8056, St Louis, MO 63110, USA.
authors.forename: Natasha Catherine
authors.initials: NC
authors.lastname: Edwin
authors.affiliation: Burkhardt Brain Tumor and Neuro Oncology Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, S73 Cleveland, OH 44195, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Khoury
authors.affiliation: Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, 9500 Euclid Avenue, R35 Cleveland, OH 44195, USA.
authors.forename: Davendra
authors.initials: D
authors.lastname: Sohal
authors.affiliation: Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, 9500 Euclid Avenue, R35 Cleveland, OH 44195, USA.
authors.forename: Keith R
authors.initials: KR
authors.lastname: McCrae
authors.affiliation: Burkhardt Brain Tumor and Neuro Oncology Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, S73 Cleveland, OH 44195, USA.
authors.forename: Manmeet S
authors.initials: MS
authors.lastname: Ahluwalia
authors.affiliation: Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, 9500 Euclid Avenue, R35 Cleveland, OH 44195, USA. Electronic address: khorana@ccf.org.
authors.forename: Alok A
authors.initials: AA
authors.lastname: Khorana
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005909:Glioblastoma / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000401:mortality* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Cancer associated thrombosis; Deep vein thrombosis; Glioblastoma multiforme; Pulmonary embolism; Venous thromboembolism