Brain Tumors and Anticoagulation
Patients with malignant gliomas are at increased risk for venous thromboembolism originating from leg and pelvic veins, with a cumulative incidence of 20 to 30%. The risk of intratumoral hemorrhage associated with anticoagulation therapy in patients with gliomas who have venous thromboembolism is low, whereas inferior vena cava filters are associated with high complication rates. Unless a patient with malignant glioma and venous thromboembolism has an intracerebral hemorrhage or other contraindications, it is generally safe to provide anticoagulation therapy for the venous thromboembolism. Low-molecular-weight heparin may be more effective and safer than warfarin.
Brain Tumors and Antiepileptics
The use of prophylactic antiepileptic drugs in patients with malignant gliomas who have never had a seizure is controversial. The American Academy of Neurology issued a practice guideline indicating that there is no evidence that prophylactic antiepileptic drugs are beneficial and advises against the routine use of antiepileptic drugs in patients with brain tumors who have not had seizures. Patients who present with seizures and a brain tumor should be treated with antiepileptic drugs. Since antiepileptic drugs that induce hepatic P-450 enzymes, such as phenytoin and carbamazepine, increase the metabolism of many chemotherapeutic agents, antiepileptic drugs that do not induce these enzymes, such a levetiracetam, are generally preferred.
New England Journal of Medicine - Vol. 359, No. 5, July 31, 2008