Abstract：
To evaluate the safety of direct oral anticoagulants (DOACs) versus low-molecular weight heparin (LMWH) in patients with central nervous system (CNS) malignancies and secondary metastases. All adult patients with CNS malignancies and secondary metastases who were treated with a DOAC or LMWH for any indication from 2018 to 2022 were included. The primary outcome was the incidence of any intracranial hemorrhage (ICH) after anticoagulation initiation. Secondary outcomes included non-ICH bleeding events and thromboembolic events. Tolerability was assessed by any changes in anticoagulant therapy during study period. 153 patients were included; 48 patients received enoxaparin and 105 received DOACs, of which apixaban was used most commonly. The population was predominantly White (74%) and male (59%) with a median age of 65. Data was censored for immortal time bias for outcomes evaluated beyond 3 months. ICH occurred in 7.7% of the population, more frequently in the enoxaparin group (DOACs 4, 4% vs. enoxaparin 7, 16%, p = 0.037). Non-ICH bleeds were predominantly minor and more common in the DOAC group (DOACs 13, 13% vs. enoxaparin 1, 2%, p = 0.037). Thromboembolic events were not different between groups (DOACs 9. 9% vs, enoxaparin 2, 4%, p = 0.503). Anticoagulant switches occurred more in the enoxaparin group (DOACs 12, 12.4% vs. enoxaparin, 37.8%, p < 0.001), primarily due to patient or provider preference. Our data supports DOACs to be preferred over LMWH for the treatment of VTE or for stroke prevention with AF to prevent ICH in patients with brain tumors or metastases.
摘要：
评价直接口服抗凝剂（DOAC）与低分子肝素（LMWH）治疗中枢神经系统（CNS）恶性肿瘤和继发性转移患者的安全性。纳入2018年至2022年期间，所有患有中枢神经系统恶性肿瘤和继发性转移的成人患者，均接受DOAC或LMWH治疗。主要结果是抗凝开始后任何颅内出血（ICH）的发生率。次要结局包括非ICH出血事件和血栓栓塞事件。通过研究期间抗凝治疗的任何变化来评估耐受性。纳入153例患者；48例患者接受依诺肝素，105例接受DOAC，其中阿哌沙班最常用。人口主要是白人（74％）和男性（59％），中位年龄为65岁。对于评估超过3个月的结果，数据被审查为不朽的时间偏差。ICH发生在7.7%的人口中，依诺肝素组更常见(DOACs4，4%vs.依诺肝素7,16%,p=0.037)。非ICH出血主要是轻微的，在DOAC组中更常见(DOACs13，13%与依诺肝素1，2%，p=0.037)。组间血栓栓塞事件没有差异（DOACs9。9%vs.依诺肝素2，4%，p=0.503）。抗凝开关在依诺肝素组中发生更多（DOACs12，12.4%vs.依诺肝素,37.8%,p<0.001)，主要是由于患者或提供者的偏好。我们的数据支持DOAC优于LMWH用于治疗VTE或AF预防中风，以预防脑肿瘤或转移患者的ICH。
