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


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


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