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Complications of therapy for venous thromboembolic disease in patients with brain tumors

Division of Neurology (Drs. Levin, Schiff, and Wen), Joint Center for Radiation Therapy (Dr. Loeffler), and Division of Neurosurgery (Dr. Black), Brigham and Women's Hospital, Boston; the Department of Medical Oncology (Dr. Fine), Dana Farber Cancer Institute, Boston; and the Departments of Neurology (Drs. Levin, Schiff, and Wen), Radiation Oncology (Dr. Loeffler), Medicine (Dr. Fine), and Surgery (Dr. Black), Harvard Medical School, Boston, MA.
Supported in part by NIH grant Kll CA01492.

Venous thromboembolic disease is a frequent complication in patients with intracranial malignancies. Because these patients are often perceived to be at increased risk of intracranial hemorrhage with anticoagulation, inferior vena cava (IVC) filters are frequently used in their treatment. We reviewed the records of 49 patients with intracranial malignancies and venous thromboembolic disease to determine the effectiveness of, and the complications resulting from, treatment. Of the 42 patients receiving IVC filters, a strikingly high percentage (62%) developed complications. Twelve percent developed recurrent pulmonary embolism, while 57% developed either IVC or filter thrombosis, recurrent deep venous thrombosis, or post-phlebitic syndrome. These complications severely reduced the quality of life of the affected patients. Only 15 of our patients were treated with anticoagulation, and seven of these received it because of continued thromboembolic disease. None of these 15 patients had proven hemorrhagic complications. This study suggests that the complication rate of IVC filters in patients with brain tumors is higher than commonly perceived and may outweigh the risk of anticoagulation.

Address correspondence and reprint requests to Dr. Patrick Wen, Division of Neurology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.

Received August 12, 1992. Accepted for publication in final form October 5, 1992.

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