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Safety of anticoagulation use and bevacizumab in patients with glioma

Departments of Neurology (P.L.N., A.L, T.F.C.) and Radiological Sciences (W.B.P.) and Jonsson Comprehensive Cancer Center, (T.F.C.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Henry E. Singleton Brain Cancer Research Program, Los Angeles, CA (P.L.N., A.L, T.F.C.); Department of Neurology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA (R.M.G.)

Address correspondence to Phioanh (Leia) Nghiemphu, Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, RNRC 1-230, Los Angeles, CA 90095, USA (leian{at}ucla.edu).

Bevacizumab in combination with chemotherapy is now being studied for the treatment of malignant gliomas. However, the risk of intracranial hemorrhage has limited its use in patients requiring full anticoagulation for venous thrombosis. To assess the safety of using anticoagulation with bevacizumab, we conducted a retrospective review of our patients who were treated with bevacizumab while receiving anticoagulation. We reviewed their medical records and imaging for signs of hemorrhage. In total, we had 21 patients who received anticoagulation and bevacizumab concurrently for a median time of 72 days. Eighteen patients had adequate anticoagulation for venous thrombosis. There were no frank lobar hemorrhages in any patient. Three patients had small, intraparenchymal hemorrhages on MRI, but only one patient actually developed symptoms due to the hemorrhage. None of these patients had residual neurological deficits from the hemorrhages. Two more patients had evidence of a minor increase in signal on noncontrast T1-weighted sequence, presumed to be petechial hemorrhages, without any clinical sequelae or progression. In contrast, seven patients who had symptomatic hemorrhages from bevacizumab were not on any anticoagulation. In this retrospective review, anticoagulation did not lead to any major hemorrhages and does not appear to be a contraindication for starting bevacizumab therapy.

Key Words: anticoagulation • bevacizumab • glioma • hemorrhage

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