ArticleBlood advances2020
Intracranial hemorrhage with direct oral anticoagulants in patients with brain metastases.
Article in Blood advances, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- Pooled it
- ICH in primary or metastatic brain cancer patients with or without anticoagulant treatment: a systematic review and meta-analysis.Blood advances · 2022Pooled it
- Treatment Algorithm in Cancer-Associated Thrombosis: Updated Canadian Expert Consensus.Current oncology (Toronto, Ont.) · 2021Pooled it
- Disease-specific safety and efficacy of DOACs vs LMWH for CAT in patients with brain metastases: a real-world analysis.Blood vessels, thrombosis & hemostasis · 2026Article
- Article
- Intracranial hemorrhage in patients with primary brain cancer receiving anticoagulation.Blood vessels, thrombosis & hemostasis · 2026Article
- Outcomes and risk factors of hemorrhage in patients with resected brain metastases.International journal of cancer · 2026Article
- Evidence gap in predicting intracranial haemorrhage risk in people with glioma on anticoagulants: a scoping review.BMC neurology · 2025Article
- Multinational cohort study of intracranial hemorrhage in patients with brain metastases receiving anticoagulation.Haematologica · 2025Article
- Article
- Successful combined treatment for primary central nervous system lymphoma with massive hemorrhage: Illustrative case.Surgical neurology international · 2025Article
- Clinical Challenges in Treating Cancer-Associated Thrombosis: A Clinically Oriented Review.Acta haematologica · 2025Review
- Management of anticoagulation in patients with brain metastasis.Hematology. American Society of Hematology. Education Program · 2024Review
- Article
- Anticoagulant prescribing patterns in patients with primary central nervous system malignancies and secondary metastases.Journal of thrombosis and thrombolysis · 2024Article
- Abelacimab in Cancer-Associated Thrombosis: The Right Drug at the Right Time for the Right Purpose. A Comprehensive Review.Reviews in cardiovascular medicine · 2023Review
- Direct Oral Anticoagulants for Cancer-Associated Venous Thromboembolism.Current oncology reports · 2023Review
- DOACs for VTE in patients with brain cancer and brain metastases: choices, choices, choices.Blood advances · 2023Article
- Intra-and peritumoral hemorrhage in the meningioma of a nonagenarian due to administration of direct oral anticoagulants after mechanical thrombectomy.Surgical neurology international · 2023Article
- Risk factors and a new nomogram for predicting brain metastasis from lung cancer: a retrospective study.Frontiers in oncology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Direct oral anticoagulants (DOACs) are increasingly prescribed in treatment of cancer-associated thrombosis, but limited data exist regarding safety of DOACs in patients with brain metastases. We aimed to determine the incidence of intracranial hemorrhage (ICH) in patients with brain metastases receiving DOACs or low-molecular-weight heparin (LMWH) for venous thromboembolism or atrial fibrillation. An international 2-center retrospective cohort study was designed. Follow-up started on the first day of concomitant anticoagulation and brain tumor diagnosis. At least 2 brain imaging studies were mandated. The primary outcome was the cumulative incidence of any spontaneous ICH at 12-month follow-up with death as a competing risk. Major ICH was defined as spontaneous, ≥10 mL in volume, symptomatic, or requiring surgical intervention. Imaging studies were centrally reviewed by a neuroradiologist blinded for anticoagulant type. PANWARDS (platelets, albumin, no congestive heart failure, warfarin, age, race, diastolic blood pressure, stroke) score for prediction of ICH was calculated. We included 96 patients with brain metastases (41 DOAC, 55 LMWH). The 12-month cumulative incidence of major ICH was 5.1% in DOAC-treated patients and 11.1% in those treated with LMWH (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.09-2.21). When anticoagulation was analyzed as a time-varying covariate, the risk of any ICH did not differ between DOAC- and LMWH-treated patients (HR, 0.98; 95% CI, 0.28-3.40). PANWARDS score was not associated with ICH risk. This international 2-center study suggests comparable safety of LMWH and DOACs in patients with brain metastases.
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