title: Prevention and treatment of venous thromboembolism in patients with solid brain neoplasms: results of a survey among Italian physicians.
abstract: The decision concerning the introduction of primary and secondary prophylaxis of venous thromboembolism (VTE) in patients with solid brain neoplasms and brain metastases is often challenging due to the concomitant increased risk of intracranial hemorrhage and to limited evidence from available literature. A standardized questionnaire composed of nine multiple-choice questions regarding primary VTE prevention in non-surgical patients during high-risk conditions and VTE secondary prevention in patients with a solid brain neoplasm or cerebral metastases was sent via electronic mail to all the members (n = 2420) of the Italian Federation of the Internal Medicine Hospital Executives' Associations (FADOI) in June 2015. Three hundred and fifty two physicians (14.5%) returned it (participants' median age 51 years; females 46.9%). The majority of respondents prescribe primary thromboprophylaxis (usually with heparin) in non-surgical patients with solid brain neoplasms and brain metastases in concomitance with high-risk conditions. Full-dose anticoagulation with either low-molecular-weight heparin or fondaparinux is the preferred option for acute VTE (69.6%), while a reduced dose is chosen by 21.0% of physicians. The presence of a highly vascular brain neoplasm histotype mandates the prescription of a reduced-dose antithrombotic regimen in a minority of respondents. Vena cava filter placement is an option for the treatment of acute VTE in more than 6% of respondents. Anticoagulants are often prescribed for both VTE primary prevention and treatment. In conclusion, physicians' managements are partially in contrast to recent guidelines, reinforcing the need for educational programs and other studies in this setting.
authors.affiliation: Department of Internal Medicine, Ospedale Civile di Livorno, Viale Alfieri, 36, 57124, Livorno, Italy. nimumoli@tiscali.it.
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0001-7166-5630
authors.initials: N
authors.lastname: Mumoli
authors.affiliation: Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Stefano
authors.initials: S
authors.lastname: Barco
authors.affiliation: Department of Internal Medicine, Ospedale Civile di Livorno, Viale Alfieri, 36, 57124, Livorno, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cei
authors.affiliation: Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Giorgi-Pierfranceschi
authors.affiliation: Department of Internal Medicine, Ospedale Maggiore della Carità, Novara, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Campanini
authors.affiliation: Department of Internal Medicine, Ospedale Fatebenefratelli, Napoli, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontanella
authors.affiliation: Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Ageno
authors.affiliation: Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000628:therapy*; D002983:Clinical Competence / Q000592:standards*; D032921:Consensus; D005260:Female; D000077425:Fondaparinux; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology; D011134:Polysaccharides / Q000009:adverse effects / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D054556:Venous Thromboembolism / Q000517:prevention & control* / Q000628:therapy*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D000077425:Fondaparinux
keywords: Anticoagulants; Internal medicine; Solid brain cancer; Survey; Thromboprophylaxis; Venous thromboembolism