Intracerebral hemorrhage risk in glioma patients taking direct oral anticoagulants as compared with low molecular weight heparin.

Abstract: BackgroundGlioma patients may require long-term anticoagulation for comorbidities, including arrhythmias or venous thromboembolism (VTE). While direct oral anticoagulants (DOACs) have demonstrated safety in general cancer populations, safety data for glioma patients remains limited. The aim of this study was to assess intracerebral hemorrhage (ICH) risk with DOAC compared to low molecular weight heparin (LMWH) in glioma patients. Methods: We reviewed adult patients with primary glioma who received DOAC and/or LMWH for at least 10 days between 2008 and 2023 across Cleveland Clinic Health System hospitals. ICH rates and severity were compared between treatment groups. Results: Among 277 patients (147 DOAC, 130 LMWH), median time from tumor diagnosis to first VTE was 70 days, with 32% experiencing VTE within six months of glioma diagnosis. Of these, 74% had glioblastoma. No statistically significant difference in ICH risk was found between DOAC and LMWH groups (P = .3) or across tumor grades (P = .6). Six ICH events occurred: three trace/minor, one subdural, and two major/fatal (both in LMWH patients). Five events occurred in glioblastoma patients and one in a patient with oligodendroglioma. Conclusions: This observational study suggests DOACs are relatively safe in glioma patients given the low ICH risk. While most ICH events occurred in glioblastoma patients, no significant difference in risk was found across tumor grades. Prospective studies will establish anticoagulation risks in this population.