Skip to main content

The Use of Low Molecular Weight Heparin in the Treatment and Prevention of Thromboembolic Disease in Glioma Patients

  • Chapter
  • First Online:
Tumors of the Central Nervous System, Volume 2

Part of the book series: Tumors of the Central Nervous System ((TCNS,volume 2))

  • 1762 Accesses

Abstract

The neuro-oncologist routinely deals with an extraordinarily high risk patient population relative to thromboembolic disease. With the advent of easily accessible diagnostic studies, e.g., ultrasound and/or spiral CT scans, timely diagnosis of venous thromboembolic events (VTE) is readily accomplished. The introduction of low molecular weight heparin (LMWH) about 20 years ago (in contrast to unfractionated heparin and vitamin K antagonists) has provided a class of agents with a favorable therapeutic index. In the review to follow, the literature regarding the use of LMWH in neuro-oncology patient populations is summarized. Topics addressed include prophylaxis, treatment, as well as consideration of the potential anti-neoplastic properties of these drugs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Agnelli G, Piovella F, Buoncristiani P, Severi P, Pini M, D’Angelo A, Beltrametti C, Damiani M, Andrioli GC, Pugliese R, Iorio A, Brambilla G (1998) Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 339:80–85

    Article  PubMed  CAS  Google Scholar 

  • Bitan M, Mohsen M, Levi E, Wygoda MR, Miao H, Lider O, Svahn CM, Ekre HP, Ishai-Michaeli R, Bar-Shavit R, Vlodavsky I, Peretz T (1995) Structural requirements for inhibition of melanoma lung colonization by heparanase inhibiting species of heparin. Isr J Med Sc 31:106–118

    CAS  Google Scholar 

  • Brisman R, Mendell J (1973) Thromboembolism and brain tumor. J Neurosurg 38:337–338

    Article  PubMed  CAS  Google Scholar 

  • Buller HR, Davidson BL, Decousus H, Gallus A, Gent M, Piovella F, Prins MH, Raskob G, Segers AE, Cariou R, Leeuwenkamp O, Lensing AW (2004) Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial. Ann Intern Med 140:867–873

    PubMed  Google Scholar 

  • Castellot JJ, Jr, Choay J, Lormeau J, Petitou M, Sache E, Kamovsky MJ (1986) Structural determinants of the capacity of heparin to inhibit the proliferation of vascular smooth muscle cells. II. Evidence for a pentasaccharide sequence that contains a 3-0-sulfate group. J Cell Biol 102:1979–1984

    Article  PubMed  CAS  Google Scholar 

  • Collen A, Smorenburg SM, Peters E, Lupu F, Koolwijk P, van Noordan C, van Hinsbergh VWM (2000) Unfractionated and low molecular weight heparin affect fibrin structure and angiogenisis in vitro. Cancer Res 60:6196–6200

    PubMed  CAS  Google Scholar 

  • Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Fischbach AJ, Chang CH, Rotman M, Asbell SO, Krisch RE (1993) Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 85:704–710

    Article  PubMed  Google Scholar 

  • Deitcher SR, Kessler CM, Merli G, Rigas JR, Lyons RM, Fareed J (2006) Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost 12:389–396

    Article  PubMed  CAS  Google Scholar 

  • Dickinson LD, Miller LD, Patel CP, Gupta SK (1998) Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors. Neurosurgery 43:1074–1081

    Article  PubMed  CAS  Google Scholar 

  • Dunn IF, Hesse O, Black PM (2004) Growth factors in glioma angiogenesis: FGFs, PDGF, EGF, and TGFs. J Neurooncol 50:121–137

    Article  Google Scholar 

  • Folkman J, Langer R, Linhardt RJ, Haudenschild C, Taylor S (1983) Angiogenesis inhibition and tumor regression caused by heparin or a heparin fragment in the presence of cortisone. Science 221:719–725

    Article  PubMed  CAS  Google Scholar 

  • Hamilton MG, Hull RD, Pineo GF (1994) Venous thromboembolism in neurosurgery and neurology patients: A review. Neurosurgery 34:280–296

    Article  PubMed  CAS  Google Scholar 

  • Hull RD, Pineo GF, Brant RF, Mah AF, Burke N, Dear R, Wong T, Cook R, Solymoss S, Poon MC, Raskob G (2006) Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med 119:1062–1072

    Article  PubMed  CAS  Google Scholar 

  • Iberti TJ, Miller M, Abalos A, Fischer EP, Post KD, Benjamin E, Oropello JM, Wiltshire-Clement M, Rand JH (1994) Abnormal coagulation profile in brain tumor patients during surgery. Neurosurgery 34:389–395

    Article  PubMed  CAS  Google Scholar 

  • Investigators, P.d.R.d.E.P.p.I.C (2005) Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 112:416–422

    Google Scholar 

  • Kayser-Gatchalian MC, Kayser K (1975) Thrombosis and intracranial tumors. J Neurol 209:217–224

    Article  PubMed  CAS  Google Scholar 

  • Lee AY (2009) Anticoagulation in the treatment of established venous thromboembolism in patients with cancer. J Clin Oncol 27:4895–4901

    Article  PubMed  CAS  Google Scholar 

  • Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, Rickles FR, Julian JA, Haley S, Kovacs MJ, Gent M (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349:146–153

    Article  PubMed  CAS  Google Scholar 

  • Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D, Flowers C, Jahanzeb M, Kakkar A, Kuderer NM, Levine MN, Liebman H, Mendelson D, Raskob G, Somerfield MR, Thodiyil P, Trent D, Francis CW (2007) American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 25:5490–5505

    Article  PubMed  CAS  Google Scholar 

  • Marras LC, Geerts WH, Perry JR (2000) The risk of venous thromboembolism is increased throughout the course of malignant glioma: an evidence-based review. Cancer 89:640–646

    Article  PubMed  CAS  Google Scholar 

  • Meyer G, Marjanovic Z, Valcke J, Lorcerie B, Gruel Y, Solal-Celigny P, Le Maignan C, Extra JM, Cottu P, Farge D (2002) Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 162:1729–1735

    Article  PubMed  CAS  Google Scholar 

  • Millac P (1967) Platelet stickiness in patients with intracranial tumors. BMJ 4:25–26

    Article  PubMed  CAS  Google Scholar 

  • Nathanson M, Savitsky JP (1952) Platelet adhesive index studies in multiple sclerosis and other neurological disorders. Bull NY Acad Med 28:462–468

    CAS  Google Scholar 

  • Norrby K (1993) Heparin and angiogenesis: a low-molecular-weight fraction inhibits and a highmolecular-weight fraction stimulates angiogenesis systemically. Haemostasis 23(Suppl 1):141–149

    PubMed  CAS  Google Scholar 

  • Nurmohamed MT, van Riel AM, Henkens CM, Koopman MM, Que GT, d’Azemar P, Buller HR, ten Cate JW, Hoek JA, van der Meer J, van der Heul C, Turpie AG, Haley S, Sicurella A, Gent M (1996) Low molecular weight heparin and compression stockings in the prevention of venous thromboembolism in neurosurgery. Thromb Haemost 75:233–238

    PubMed  CAS  Google Scholar 

  • Perry JR, Rogers L, Laperrier N, Julian J, Geerts W, Agnelli G, Malkin M, Sawaya R, Baker R, Levine M (2007a) A phase III randomized placebo-controlled trial of thromboprophylaxis using dalteparin low molecular weight heparin (LMWH) in patients with newly diagonsed malignant glioma updated results. Thromb Res 120:ABS PO–40

    Article  Google Scholar 

  • Perry JR, Rogers L, Laperriere N, Julian J, Geerts W, Agnelli G, Malkin M, Sawaya R, Baker R, Levine M (2007b) PRODIGE: a Phase III randomized placebo-controlled trial of thromboprophylaxis using dalteparin low molecular weight heparin (LMWH) in patients with newly diagnosed malignant glioma. J Clin Oncol 25:77s (Abstr 2011)

    Google Scholar 

  • Quevedo JF, Buckner JC, Schmidt JL, Dinapoli RP, O’Fallon JR (1994) Thromboembolism in patients with high-grade glioma. Mayo Clin Proc 69:329–332

    PubMed  CAS  Google Scholar 

  • Robins HI, O’Neill A, Gilbert M, Olsen M, Sapiente R, Berkey B, Mehta M (2008) Effect of dalteparin and radiation on survival and thromboembolic events in glioblastoma multiforme: a phase II ECOG trial. Cancer Chemother Pharmacol 62:227–233

    Article  PubMed  CAS  Google Scholar 

  • Rong Y, Durden DL, Van Meir EG, Brat DG (2006) Differential regulation of tissue factor expression by EGFR and EGFRvIII in GBM. Neuro-Oncology 8:401 (ABS CB–27)

    Google Scholar 

  • Ruff RL, Posner JB (1983) Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol 13:334–336

    Article  PubMed  CAS  Google Scholar 

  • Sawaya R, Highsmith RF (1988) Brain tumors and the fibrinolytic enzyme system. In: Kornblith PL, Walker MD (eds) Advances in neuro-oncology. Futura, Mount Kisco, NY, pp 103–157

    Google Scholar 

  • Sawaya R, Highsmith RF (1992) Postoperative venous thromboembolism and brain tumors: Part III. Biochemical profile. J Neuro-Oncol 14:113–118

    CAS  Google Scholar 

  • Sawaya R, Zuccarrello M, Elkalliny M, Nishiyama H (1992) Postoperative venous thromboembolism and brain tumors: Part I. Clinical Profile. J Neurooncol 14:119–125

    PubMed  CAS  Google Scholar 

  • Shlebak AA, Smith DB (1997) Incidence of objectively diagnosed thromboembolic disease in cancer patients undergoing cytotoxic chemotherapy and/or hormonal therapy. Cancer Chemother Pharmacol 39:462–466

    Article  PubMed  CAS  Google Scholar 

  • Siragusa SCB, Piovella F, Hirsh J, Ginsberg S (1996) Low-molecular-weight heparins and unfractionated heparin in the treatment of patients with acute venous thromboembolism: Results of a meta-analysis. J Am Med 100:269–277

    Article  CAS  Google Scholar 

  • Stupp R, Mason WP, Van Den Bent MJ, Weller M, Fisher B, Taphoorn M, Brandes AA, Cairncross G, Lacombe D, Mirimanoff RO (2004) Conclusive results of a randomized phase III trial by the EROTC Brain and RT groups and NICIC Clinical Trails Group. Concomitant and adjuvant temozolomide and radiotherapy for newly diagnosed glioblastoma multiforme. Proc Am Soc Clin Oncol 23:1 (Abstract 2)

    Google Scholar 

  • Teicher BA, Holden SA, Ara G, Dupuis NP, Liu F, Yuan J, Ikebe M, Kakeji Y (1995) Influence of an antiangiogenic treatment on 9L gliosarcoma: oxygenation and response to cytotoxic therapy. Int J Cancer 61:732–737

    Article  PubMed  CAS  Google Scholar 

  • van Dongen CJ, van den Belt AG, Prins MH, Lensing AW (2004) Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev CD001100:1–92

    Google Scholar 

  • Wachsberger P, Burd R, Dicker AP (2003) Tumor response to ionizing radiation combined with antiangiogenesis or vascular targeting agents. Clin Cancer Res 9:1957–1971

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to H. Ian Robins .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media B.V.

About this chapter

Cite this chapter

Chao, B.H., Robins, H.I. (2011). The Use of Low Molecular Weight Heparin in the Treatment and Prevention of Thromboembolic Disease in Glioma Patients. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 2. Tumors of the Central Nervous System, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0618-7_37

Download citation

  • DOI: https://doi.org/10.1007/978-94-007-0618-7_37

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-0617-0

  • Online ISBN: 978-94-007-0618-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics