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Safety of Antiplatelet Therapy in Patients with CNS Metastases
Central nervous system (CNS) metastases increase the risk for intracranial hemorrhage (ICH) in oncology patients with advanced malignancies. These patients are similarly at risk for venous thromboembolic events — with caution, anticoagulation is usually permissible in patients with CNS metastases. When there is comorbid cardiovascular disease, antiplatelet therapies are often considered in patients with CNS metastases; however, whether antiplatelet therapies can be used safely in this patient population is unknown. To address this, investigators conducted a single-center, retrospective, matched cohort study of 392 patients with CNS metastases. The primary endpoint was the cumulative incidence of ICH in patients starting antiplatelet therapy (aspirin or P2Y12 inhibitors) after tumor diagnosis.
Among the findings:
- Of the 392 patients, 134 were taking antiplatelet agents, most commonly aspirin (86.6%).
- The most common primary malignancies included lung cancer, melanoma, and renal cell cancer.
- The rate of ICH at 1 year was statistically similar in patients taking and those not taking antiplatelet agents (22.5% and 19.3%; P=0.22).
- In the subset of patients taking anticoagulants in addition to antiplatelet agents (23.1%) there was no increase in risk of major ICH.
- There was a slight survival advantage in patients exposed versus not exposed to antiplatelet agents (median survival, 9.4 vs. 8.2 months; P=0.03).
Comment
This study addresses an important question about the safety of using antiplatelet therapy in patients with CNS metastases. As with use of anticoagulation, the rate of ICH is high in these patients, but is not clearly exacerbated by antiplatelet therapy. The study showed no association between antiplatelet use and the incidence, size, or severity of ICH. Surprisingly, there was no negative impact when anticoagulation was combined with antiplatelet therapy, although this group was a small subset of the cohort. A slight survival benefit in patients taking antiplatelet therapies was also a surprising finding. Although there are limitations to a retrospective study, these findings justify use of antiplatelet therapies in patients with CNS metastases, provided there is a strong and independent indication for their use.
Citation(s)
Author:
Miller EJ et al.
Title:
Antiplatelet medications and risk of intracranial hemorrhage in patients with metastatic brain tumors.
Source:
Blood Adv
2022
Mar
8; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Brady L. Stein, MD, MHS