Management of Thromboembolic Disease in Patients with Primary and Metastatic Brain Tumors

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  Fig. 1. A conceptual framework assisting the assessment of risks and benefits of anticoagulation over time. Time point A. An acute VTE event is associated with a high initial risk. Benefit to anticoagulation is strong. Anticoagulation risk is relatively moderate and may be higher during the initial “loading” phase. B. General risk of the acute thrombosis falls with time and approaches the chronic risk level at 3–6 months. Chronic risk persists, particularly in the setting of malignancy or other risks factors. If the chronic thrombosis risk remains elevated (as in most CNS cancer processes) the benefit to long-term treatment would be expected to exceed the bleeding risk, and there is net benefit to remaining on anticoagulation. Time point C. This risk/benefit balance is not static, and may vary based on the clinical status (e.g., a period of severe thrombocytopenia).