Associations of anticoagulant use with outcome in newly diagnosed glioblastoma

Emilie Le Rhun*, Els Genbrugge, Roger Stupp, Olivier L. Chinot, L. Burt Nabors, Timothy Cloughesy, David A. Reardon, Wolfgang Wick, Thierry Gorlia, Michael Weller

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: To test the hypothesis that despite bleeding risk, anticoagulants improve the outcome in glioblastoma because of reduced incidence of venous thromboembolic events and modulation of angiogenesis, infiltration and invasion. Methods: We assessed survival associations of anticoagulant use from baseline up to the start of temozolomide chemoradiotherapy (TMZ/RT) (period I) and from there to the start of maintenance TMZ chemotherapy (period II) by pooling data of three randomised clinical trials in newly diagnosed glioblastoma including 1273 patients. Progression-free survival (PFS) and overall survival (OS) were compared between patients with anticoagulant use versus no use; therapeutic versus prophylactic versus no use; different durations of anticoagulant use versus no use; anticoagulant use versus use of anti-platelet agents versus neither anticoagulant nor anti-platelet agent use. Cox regression models were stratified by trial and adjusted for baseline prognostic factors. Results: Anticoagulant use was documented in 75 patients (5.9%) in period I and in 104 patients (10.2%) in period II. Anticoagulant use during period II, but not period I, was associated with inferior OS than no use on multivariate analysis (p = 0.001, hazard ratio [HR] = 1.52, 95% confidence interval [CI]: 1.18–1.95). No decrease in OS became apparent when only patients with prophylactic anticoagulant use were considered. No survival association was established for anti-platelet agent use. Conclusions: Anticoagulant use was not associated with improved OS. Anticoagulants may not exert relevant anti-tumour properties in glioblastoma.

Original languageEnglish (US)
Pages (from-to)95-104
Number of pages10
JournalEuropean Journal of Cancer
Volume101
DOIs
StatePublished - Sep 2018

Keywords

  • Brain
  • Embolism
  • Glioma
  • Heparin
  • Prognosis
  • Pulmonary
  • Survival
  • Thrombosis
  • Vitamin K

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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