In a retrospective study, patients with glioblastoma showed high rates of venous thromboembolism (VTE) and major bleeding (MB). Results of this study were presented at the International Society on Thrombosis and Haemostasis (ISTH) 2021 Congress by Fleur Kaptein, MD, of Leiden University Medical Center (LUMC) in Leiden, the Netherlands, and colleagues.
This study included patients seen at the LUMC and at Haaglanden Medical Center in the Netherlands who had been diagnosed with glioblastoma during the years of 2004 through 2020. Patient information was evaluated from 6 months prior to diagnosis and for a maximum of 2 years after diagnosis. VTE and MB were evaluated as primary study endpoints, and risk factors and prognostic impacts of VTE or MB were also examined.
A total of 967 patients were included in this analysis. The majority, or 630 patients (65%), had died by the end of observation. Patients had a mean age of 63 years (SD, 12) at diagnosis, and the majority (60%) were male. Surgical resection was used in 75% of cases, while biopsy was used for 25% of patients.
The median study follow-up was 15 months. Adjusted 2.5-year cumulative incidences were 12% (95% CI, 10%-14%) for VTE and 16% (95% CI, 13%-18%) for MB. VTE and MB were also both independently associated with mortality. All-cause mortality was associated with VTE at an adjusted hazard ratio (aHR) of 1.3 (95% CI, 1.0-1.7) and with MB at an aHR of 1.7 (95% CI, 1.3-2.1).
VTE had multiple predictors. These included Eastern Cooperative Oncology Group (ECOG) performance status of ≥2 versus <2 (aHR, 1.9; 95% CI, 1.2-2.9), tumor resection versus biopsy (aHR, 0.53; 95% CI, 0.33-0.85), and each 1-year age increase (aHR, 1.03; 95% CI, 1.01-1.05).
Predictors of mortality included ECOG performance status of ≥2 versus <2 (aHR, 2.3; 95% CI, 1.9-2.7), surgical resection versus biopsy (aHR, 0.37; 95% CI, 0.31-0.44), and each 1-year age increase (aHR, 1.04; 95% CI, 1.03-1.05).
MBs were intracranial in 94% of cases. Of these, 51% were postoperative. Additionally, VTE occurring while under observation during anticoagulation treatment was a predictor of MB (aHR, 4.7; 95% CI, 2.5-9.0).
Dr Kaptein and colleagues concluded that cumulative incidences of VTE and MB were both high in patients with glioblastoma, and they considered prognosis to be poor for each. They also indicated that prospective studies are needed to ascertain the best VTE prophylaxis and treatment approaches for patients with glioblastoma.
Kaptein FHJ, Stals MAM, Klaase E, et al. Incidence and impact of venous thromboembolism and major bleeding in patients with glioblastoma. Paper presented at: International Society on Thrombosis and Haemostasis (ISTH) 2021 Congress; July 17-21, 2021; virtual. Abstract PB1100.