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Anti-platelet Drugs and Risk of Intracranial Hemorrhage in Patients with Metastatic Brain Tumors

1Beth Israel Deaconess Medical Center, Department of Internal Medicine, Boston, United States, 2Beth Israel Deaconess Medical Center, Department of Hematology and Hematologic Malignancies, Boston, United States, 3Beth Israel Deaconess Medical Center, Department of Neurology, Boston, United States, 4Dana Farber Cancer Institute, Department of Data Science, Boston, United States, 5Harvard Medical School, Department of Bioinformatics, Boston, United States

Abstract Number: PB0748

Meeting: ISTH 2021 Congress

Theme: Role of Hemostatic System in Cancer, Inflammation and Immunity » Platelets and Cancer

Background: Intracranial hemorrhage (ICH) is frequent in patients with intracranial malignancy but data are lacking on the risk of ICH with antiplatelet agents in patients with brain metastases.

Aims: We investigated whether patients with metastatic brain tumors receiving antiplatelet agents had an increased risk of ICH compared to a matched cohort.

Methods: We performed an Institutional Review Board approved retrospective matched cohort study of patients with brain metastases at primary tumor diagnosis treated at our center between 2010-2019. Patients with brain metastases treated with antiplatelet agents (aspirin and P2Y12 inhibitors) were matched with patients not receiving antiplatelet agents. The primary endpoint was cumulative incidence of ICH at one year after primary tumor diagnosis accounting for death as a competing risk. Intracranial hemorrhage was classified as trace (<1 cm3), measurable (1 – 10 cm3), or major (symptomatic or > 10 cm3) by a neuro-oncologist blinded to cohort allocation.

Results: Study population included 392 patients with brain metastases (134 patients exposed to antiplatelet agents). Most common malignancies were non-small cell lung cancer (74.0%), small cell lung cancer (9.9%), melanoma (4.6%), and renal cell carcinoma (4.3%). Cumulative incidence of any ICH at 1 year was 19.3% (95% CI, 14.1-24.4%) in patients not receiving anti-platelet agents compared with 22.5% (95% CI, 15.2-29.8%, Gray test P=0.22) in those receiving antiplatelet agents. Cumulative incidence of major ICH was 5.4% (95% CI, 2.6-8.3%) among controls compared with 5.5% (95% CI, 1.5-9.5%, Gray test P=0.8) in those receiving antiplatelet agents. Antiplatelet agent use did not significantly increase the risk of all ICH (HR 1.4, 95% CI 0.9 – 2.1) or major ICH (HR 1.1, 95% CI 0.5 – 2.6); inclusion of anticoagulation in the model did not alter the risk.

Conclusions: In patients with brain metastases, administration of antiplatelet agents was not associated with an increased incidence of ICH.

To cite this abstract in AMA style:

Miller E, Patell R, Uhlmann E, Ren S, Southard H, Elavalakanar P, Weber G, Neuberg D, Zwicker J. Anti-platelet Drugs and Risk of Intracranial Hemorrhage in Patients with Metastatic Brain Tumors [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/anti-platelet-drugs-and-risk-of-intracranial-hemorrhage-in-patients-with-metastatic-brain-tumors/. Accessed September 27, 2023.

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