Direct oral anticoagulants or low-molecular-weight heparins for venous thromboembolism in patients with brain tumors

Thromb Res. 2021 Dec;208:148-155. doi: 10.1016/j.thromres.2021.10.023. Epub 2021 Oct 29.


Introduction: Patients with central nervous system malignancies have limited representation in studies evaluating DOACs for VTE treatment. This study evaluated the safety and efficacy of DOACs in comparison with LMWH for cancer-associated VTE in patients with primary brain tumors or secondary brain metastases.

Materials & methods: In this multicenter, retrospective cohort study, adult patients with a diagnosis of primary brain tumor or secondary brain metastases who received either a DOAC or LMWH for treatment of cancer-associated VTE were evaluated. The primary outcome was the cumulative incidence of any intracranial hemorrhage within a 6-month period following the initiation of anticoagulation. Secondary outcomes included the cumulative incidence of any bleeding event, and recurrent VTE events.

Results: Between January 1, 2012 and October 9, 2019, one-hundred eleven patients met inclusion criteria. The 6-month cumulative incidence of intracranial hemorrhage was 4.3% (95% CI, 0.74-13.2%) in the DOAC group, compared to 5.9% (95% CI, 1.5-14.9%) in the LMWH group (p = 0.61). The 6-month cumulative incidence of bleeding events was 14.3% (95% CI, 6.2-25.8%) in the DOAC group, compared to 27.8% (95% CI, 15.5-41.6%) in the LMWH group (p = 0.10). The 6-month cumulative incidence of recurrent VTE events was 5.6% in the DOAC group (95% CI, 1.5-14.2%), compared to 6.6% in the LMWH group (95% CI, 1.7-16.5%) (p = 0.96). No differences were found with respect to other secondary outcomes.

Conclusion: There were no significant differences in bleeding or recurrent VTE events between DOACs and LMWH. These findings suggest DOACs may be safe and effective for VTE treatment in this patient population.

Keywords: Brain neoplasms; Factor Xa inhibitors; Hemorrhage; Heparin; Low-molecular-weight; Venous thromboembolism.

Publication types

  • Multicenter Study

MeSH terms

  • Anticoagulants / adverse effects
  • Brain Neoplasms* / complications
  • Heparin, Low-Molecular-Weight / adverse effects
  • Humans
  • Retrospective Studies
  • Venous Thromboembolism* / drug therapy


  • Anticoagulants
  • Heparin, Low-Molecular-Weight