Venous thromboembolism in brain tumor patients

• Brain tumor patients develop VTE at a higher rate than patients with cancer at other sites.
• Many possible mechanisms for this difference have been proposed.
• Neurosurgeons are often hesitant to prescribe post-operative anticoagulants.
• Chemoprophylaxis in the post-operative period is safe for brain tumor patients.

Venous thromboembolism (VTE) is a relatively common and well-described condition, affecting approximately 1–2% of the general population. VTE can lead to significant morbidity and death via pulmonary embolism (PE). During the post-operative period, VTE occurs at higher rates due to natural thrombotic responses to injury and limited post-operative mobility. In general, rates of post-operative VTE are higher in patients undergoing operations for cranial and spinal lesions than for lesions of other types, a phenomenon that is not fully explained. Proposed mechanisms include increased local synthesis of tissue factor in brain tumor patients and a higher rate of paresis in patients undergoing operations on the central nervous system. Several studies have demonstrated that other risk factors for VTE include age, sex, ethnicity, hospital stay length, and coagulation state. Tumor type and size have also been explored as potential risk factors. Despite higher rates of VTE development, neurosurgeons are often hesitant to prescribe post-operative anticoagulants for fear of hemorrhage. Here we review the literature on VTE in brain tumor patients, with a focus on their etiology, diagnosis, treatment, and prophylaxis. In most brain tumor patients, aggressive chemical and mechanical VTE prophylaxis is indicated in the post-operative period to prevent the formation of VTE.