Prevention and treatment of venous thromboembolism in patients with solid brain neoplasms: results of a survey among Italian physicians

N. Mumoli1, S. Barco2, M. Cei3, M. Giorgi-Pierfranceschi3, M. Campanini4, A. Fontanella5, W. Ageno6, F. Dentali6 (1Livorno, Italy, 2Mainz, Germany, 3Piacenza, Italy, 4Novara, Italy, 5Napoli, Italy, 6Varese, Italy)

Antithrombotic treatment
Date: 17.02.2017,
Time: 17:15 - 18:15

Objective: The decision on the introduction of primary and secondary prophylaxis of venous thromboembolism in patients with solid brain neoplasms and brain metastases is often challenging due to the potential risk of an intracranial hemorrhage and to the limitation of existing literature in this setting. A survey on this topic was conducted among the members of the Italian Federation of Internal Medicine Hospital Executives' Associations (FADOI).

Methods: A standardized questionnaire composed of nine multiple-choice questions regarding primary venous thromboembolism prevention in non-surgical patients during high risk conditions and venous thromboembolism secondary prevention in patients with a solid brain neoplasm or cerebral metastases was sent via electronic mail in June 2015.

Results: 352 Italian physicians (14.5%) returned (participants median age 51 years; females 46.9%). The majority of respondents would prescribe primary thromboprophylaxis (usually with heparin) in non-surgical patients with solid brain neoplasms and brain metastases during high risk conditions. Full-dose anticoagulation with either low-molecular- weight heparin or fondaparinux was the preferred option for the acute venous thromboembolism (69.6%), while a reduced dose was chosen by 21.0% of physicians. The presence of a highly vascular brain neoplasm histotype would mandate the prescription of a reduced-dose antithrombotic regimen in a minority of respondents. Vena cava filter placement was considered an option for the treatment of acute venous thromboembolism in more than 6% and for primary thromboprophylaxis in 1.4% of respondents. Most physicians (58.6%) would call for at least one external consultancy done by another specialist before prescribing anticoagulation.

Conclusion: Our survey among a large group of Italian internists indicates that the thrombotic risk linked to the presence of solid brain cancer or brain metastases is perceived greater than the estimated bleeding risk, and anticoagulants are often prescribed for both venous thromboembolism primary prevention and treatment. Physicians’ approach is partially in contrast to the recent evidence of the literature reinforcing the need for educational programs and high quality studies in this setting.