Anticoagulation in Patients with Brain Metastases

  • Christine MarosiEmail author
  • Cihan Ay


Venous thromboembolism, e.g., deep vein thrombosis and pulmonary embolism, is frequent and is a severe complication in patients with metastatic cancer. Cancer cells are able to activate hemostasis and fibrinolysis, and an activated blood coagulation system in turn supports tumor growth and metastatic spread. An older autopsy study on 500 cancer patients from 1970 revealed that thromboembolic complications were the immediate cause of death in 18% of the patients and in 43% a related cause. Anticoagulation is effective in preventing VTE, and comes at the prize of increased bleeding, including intracranial hemorrhage. High-quality data from prospective studies in patients with brain metastasis is currently not available. A retrospective study showed that therapeutic anticoagulation with low molecular heparin does not increase the risk of intracerebral hemorrhage in patients with brain metastases. However, the risk of intracerebral bleeding must be weighted against the risk of (recurrent) VTE in each patient.

As specific data on the specific topic of blood coagulation system, thrombosis, anticoagulation and brain metastasis are scare, there is need for future basic and clinical research in this area.


Brain metastases Intracerebral hemorrhage Venous thromboembolism Deep vein thrombosis Pulmonary embolism Risk factors Low molecular heparin Direct oral anticoagulant 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Clinical Division of Oncology, Department of Medicine IMedical University of ViennaViennaAustria
  2. 2.Clinical Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria

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