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Recurrent venous thromboembolism in glioblastoma.

Al's Comment:

 As if we didn't have enough things to worry about: this report says about 1/3 of patients with a gbm developed blood clots.  This topic needs more research to weight the risks vs the benefits of putting all gbm patients on long term drugs to prevent blood clots.  The symptoms to watch out for are: acute (sudden) shortness of breath, chest pain,  coughing up blood, fainting, swelling of the legs, tenderness of the back of the legs, and warm legs.  These symptoms are an emergency and you have to see the doctor the same day. If your doctor isn't available, it is worth going to the emergency room.

 


Posted on: 12/21/2015

Thromb Res. 2015 Nov 22. pii: S0049-3848(15)30203-6. doi: 10.1016/j.thromres.2015.11.027. [Epub ahead of print]

Recurrent venous thromboembolism in glioblastoma.

Edwin NC1, Khoury MN2, Sohal D3, McCrae KR3, Ahluwalia MS2, Khorana AA4.
 
Author information:
1Division 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.
2Burkhardt Brain Tumor and Neuro Oncology Center, Neurological Institute Cleveland Clinic, 9500 Euclid Avenue, S73 Cleveland, OH 44195, USA.
3Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, 9500 Euclid Avenue, R35 Cleveland, OH 44195, USA.
4Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, 9500 Euclid Avenue, R35 Cleveland, OH 44195, USA. Electronic address: khorana@ccf.org.
 
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.
OBJECTIVES:
 
We aim to describe the treatment of incident VTE, report incidence and risk factors for recurrence.
PATIENTS/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.
CONCLUSION:
 
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.

 


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