Does therapeutic anticoagulation increase the risk of clinical relevant intracerebral haemorrhage in patients with solid malignancies and brain metastases?

In patients with melanoma brain metastases and previous intracerebral haemorrhage (ICH), anticoagulation bears a significant risk for clinically symptomatic ICH

Patients with solid malignancies from lung, breast, skin and increasingly from other cancers carry a high risk of developing brain metastases. Particularly with the development of new systemic and personalised medical therapies, the rate of overall survival in these patients is increasing. Patients with cancer, especially those with cerebral involvement, are predisposed to develop venous thromboembolism, requiring therapeutic anticoagulation.1 The application of low-molecular-weighted heparin, warfarin or direct oral anticoagulants (DOACS) presents a risk factor for intralesional and extralesional ICH. ICH may possibly lead to severe neurological impairment, necessity for brain surgery and a consecutive delay of further oncological therapy with impairment of the patient’s prognosis. More severe ICH may even be fatal.

A few recent studies with rather small sample sizes suggest that there is no higher risk of…

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