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Approaches for the prevention and treatment of venous thromboembolism in a patient with anaplastic astrocytoma: a case report

https://doi.org/10.47093/2218-7332.2021.12.1.74-82

Abstract

Venous thromboembolism occurs in 48–200 out of 1,000 patients with brain cancer per year, which is significantly more frequent than in general population.

Case report. A female patient had surgical treatment of anaplastic astrocytoma following radiotherapy and chemotherapy (temozolomide, irinotecan, bevacizumab) at the age of 17 years old. She also received dexamethasone. At the age of 20 years, she developed cancer recurrence, that required chemotherapy. After chemotherapy had been initiated, the patient developed deep vein thrombosis of the legs. Rivaroxaban 20 mg/d for 2.5 months with the subsequent switch to enoxaparin 60 mg/d showed no recanalization. Enoxaparin dose increasing up to 160 mg/d demonstrated incomplete recanalization, however, superficial venous thrombosis of the legs developed. Combination therapy with enoxaparin plus warfarin resulted in further deep and superficial veins recanalization.

Discussion. In cancer-associated venous thromboembolism that is resistant to low molecular weight heparin monotherapy, short-term combination therapy with low molecular weight heparin and vitamin K antagonists can be considered. However, in recurrent cancer standard treatment protocols can be ineffective.

About the Authors

M. G. Pavlova
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Maria G. Pavlova, Cand. of Sci. (Medicine), Associate Professor, Department of Endocrinology № 1

8/2, Trubetskaya str., Moscow, 119991



I. I. Amergulov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Ilya I. Amergulov, resident at the Department of Endocrinology № 1

8/2, Trubetskaya str., Moscow, 119991

+7 (916) 518-20-51



N. V. Likhodey
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Natalia V. Likhodey, endocrinologist, University clinic № 2

8/2, Trubetskaya str., Moscow, 119991



I. A. Kurkina
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Irina A. Kurkina, Transfusiologist, Head of Clinical Transfusiology Department, Laboratory Hematological and Transfusiological Complex of Clinical Center

8/2, Trubetskaya str., Moscow, 119991



I. V. Glinkina
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Irina V. Glinkina, Cand. of Sci. (Medicine), Associate Professor, Department of Endocrinology № 1

8/2, Trubetskaya str., Moscow, 119991



O. G. Zheludkova
Scientific and Practical Center for Specialized Medical Care for Children named after V.F. Voino-Yasenetsky
Russian Federation

Olga G. Zheludkova, Dr. of Sci. (Medicine), Professor, Oncologist, Oncology Department № 2

38, Aviatorov str., Moscow, 119620



M. Yu. Gilyarov
Sechenov First Moscow State Medical University (Sechenov University); City Clinical Hospital № 1 named after N.I. Pirogov
Russian Federation

Mihail Yu. Gilyarov, Dr. of Sci. (Medicine), Professor, Department of Cardiology, Functional and Ultrasound Diagnostics; Deputy Hospital Chief Physician (Therapy)

8/2, Trubetskaya str., Moscow, 119991; 8, Leninskiy ave., Moscow, 119049



References

1. Louis D.N., Perry A., Reifenberger G., et al. The 2016 world health organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016; 131(6): 803–820. https://doi.org/10.1007/s00401-016-1545-1 PMID: 27157931

2. Ostrom Q.T., Gittleman H., Liao P., et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007–2011. Neuro Oncol. 2014;16(4): iv1–63. https://doi.org/10.1093/neuonc/nou223 PMID: 25304271

3. Yudina A.E., Pavlova M.G., Sotnikov V.M., et al. Test s glyukagonom v diagnostike vtorichnoi nadpochechnikovoi nedostatochnosti posle kraniospinal’nogo oblucheniya: vozmozhnost’ primeneniya, osobennosti provedeniya, diagnosticheskaya informativnost’. [The glucagon test in diagnosis of secondary adrenal insufficiency after craniospinal irradiation: the feasibility of application, the features of performing the test, and its diagnostic informativity]. Problems of Endocrinology. 2019; 65(4): 227–235 (In Russian). https://doi.org/10.14341/probl10219 PMID: 32202724

4. Bobrova E.I., Pavlova M.G., Sotnikov V.M., et al. Gipopituitarizm posle oblucheniya gipotalamogipofizarnoi sistemy. [Hypopituitarism after radiotherapy on pituitary-hypothalamus area]. Clinical and experimental thyroidology, 2013; 9(3): 15–20 (In Russian).

5. Perry J.R. Thromboembolic disease in patients with high-grade glioma. Neuro Oncol. 2012; 14(4): iv73–80. https://doi.org/10.1093/neuonc/nos197 PMID: 23095833

6. Somonova O.V., Antukh EH.A., Dolgushin B.I., et al. Prakticheskie rekomendatsii po profilaktike i lecheniyu tromboehmbolicheskikh oslozhnenii u onkologicheskikh bol’nykh. [Clinical Guidelines for the Prevention and Management of Thromboembolic complications in Oncological Patients]. Malignant tumors. 2020; 10(3s2-2): 131–140 (In Russian). https://doi.org/10.18027/2224-5057-2020-10-3s2-47

7. Farge D., Frere C., Connors J.M., et al. 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol. 2019; 20(10): e566–581. https://doi.org/10.1016/S1470-2045(19)30336-5 PMID: 31492632

8. Weller M., van den Bent M., Hopkins K., et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol. 2014; 15(9): e395–403. https://doi.org/10.1016/S1470-2045(14)70011-7 PMID: 25079102

9. Key N.S., Khorana A.A., Kuderer N.M., et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2020; 38(5): 496–520. https://doi.org/10.1200/JCO.19.01461 PMID: 31381464

10. Weintraub N.L., Jones W.K., Manka D. Understanding radiationinduced vascular disease. J Am Coll Cardiol. 2010; 55(12): 1237–1239. https://doi.org/10.1016/j.jacc.2009.11.053 PMID: 20298931

11. Koo C.M., Vissapragada R., Sharp R., et al. ABO blood group related venous thrombosis risk in patients with peripherally inserted central catheters. Br J Radiol. 2018; 91(1082): 20170560. https://doi.org/10.1259/bjr.20170560 PMID: 29125332

12. Oppelt P., Betbadal A., Nayak L. Approach to chemotherapy-associated thrombosis. Vasc Med. 2015; 20(2): 153–161. https://doi.org/10.1177/1358863X14568705 PMID: 25832603

13. Steffel J., Verhamme P., Potpara T.S., et al. The 2018 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018; 39(16): 1330–1393. https://doi.org/10.1093/eurheartj/ehy136 PMID: 29562325

14. Agnelli G., Buller H.R., Cohen A., et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013; 369(9): 799–808. https://doi.org/10.1056/NEJMoa1302507 PMID: 23808982

15. Borges C., Simões J., Reis J., et al. Venous thromboembolism and intracranial hemorrhage in patients with high-grade glioma. Annals of Oncology. 2019; 30 (Supplement 5): v152–153, https://doi.org/10.1093/annonc/mdz243.029

16. Ohashi Y., Ikeda M., Kunitoh H., et al. Venous thromboembolism in cancer patients: report of baseline data from the multicentre, prospective Cancer-VTE Registry. Jpn J Clin Oncol. 2020 Oct 22; 50(11): 1246–1253. Erratum in: Jpn J Clin Oncol. 2020 Oct 22; 50(11): 1346. https://doi.org/:10.1093/jjco/hyaa112 PMID: 32715307


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ISSN 2218-7332 (Print)
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