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Venous thromboembolism and survival in patients with high-grade glioma

Division of Haematology and Haemostaseology, Department of Internal Medicine I (R.S., R.V., I.P.), Division of Oncology, Department of Internal Medicine I (M.H., C.Z., C.M.), and Department of Neurosurgery (K.R., M.S.), All Medical University, Vienna, Austria

¹ Address correspondence to Ingrid Pabinger, Division of Haematology and Haemostaseology, Department of Internal Medicine I, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (ingrid.pabinger{at}meduniwien.ac.at).

Patients with malignancy, particularly patients with high-grade glioma (HGG; WHO grade III/IV), have an increased risk of venous thromboembolism (VTE). It has been suggested that VTE predicts survival in cancer patients. The aim of our study was to investigate the occurrence of symptomatic VTE and its impact on survival in patients with HGG. Consecutive patients (n = 63; 36 female, 27 male; median age, 58 years) who had neurosurgical intervention between October 2003 and December 2004 were followed after surgery until October 2005. Objectively confirmed VTE was recorded as an event. All patients had received thrombosis prophylaxis with low-molecular-weight heparin (LMWH) during the immediate postoperative period. Subsequently, 56 patients received radiochemotherapy, 6 radiotherapy, and 1 chemotherapy only. Patients were followed over a median time period of 348 days. Fifteen patients (24%) developed VTE. Pulmonary embolism was diagnosed in nine patients (60%) and was fatal twice. The cumulative probability of VTE was 21% after three months and 26% after 12 months. The highest frequency of VTE was observed in patients with biopsy and subtotal tumor resection (n = 37; multivariate hazard ratio, 3.58; 95% CI = 0.98-13.13; P = 0.054) compared with patients with total resection. Survival did not significantly differ among patients with and without VTE and was 53% after 12 months in both groups. Patients with HGG, particularly those with biopsy and subtotal resection, are at high risk to develop VTE postoperatively. Thrombosis was not associated with a significant reduction of survival.

Key Words: cancer • glioma • neurosurgery • pulmonary embolism • venous thrombosis

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