Abstract Number: PB1100
Meeting: ISTH 2021 Congress
Background: Patients with glioblastoma are considered to be at high risk of venous thromboembolism (VTE) and major bleeding (MB), although reliable incidence estimates are lacking.
Aims: To assess the cumulative incidence, risk factors and prognostic impact of VTE and MB in a large cohort of glioblastoma patients.
Methods: Patients diagnosed with glioblastoma between 2004-2020 from the Leiden University Medical Center and Haaglanden Medical Center were included and followed from 1 year before date of histopathological glioblastoma diagnosis up to two years after, or until an outcome of interest (VTE and MB) or death occurred. Cumulative incidences were estimated using Kaplan-Meier and cumulative incidence competing risk methods. Outcome predictors were determined with multivariable (time-dependent) Cox models. The study was approved by the local Institutional Review Board and informed consent was waived.
Results: Of the 973 included patients, 615 died, 103 were diagnosed with VTE and 134 with MB during a median follow-up of 20 months (IQR 15-28). Ambulant patients did not routinely receive pharmacological thromboprophylaxis. The adjusted 3-year-cumulative incidence of VTE was 12% (95%CI 10–15) and of MB 15% (95%CI 12–17) (Figures 1&2). One year increase in age (HR 1.03, 95%CI 1.01-1.05), tumor resection (vs. biopsy: HR 0.55, 95%CI 0.34-0.88) and performance status (ECOG >1 vs ≤1: HR 1.8, 95%CI 1.2-2.8) were independent predictors of VTE (a biopsy rather than resection was performed in patients with the worst prognosis). The majority of MBs occurred within 6 weeks post-surgery (57%) and intracranially (93%). MB and VTE both predicted all-cause mortality (adjusted HR 1.6, 95%CI 1.3-2.0 and 1.3, 95%CI 0.99-1.7 respectively).
Conclusions: The incidences of VTE and MB in patients with glioblastoma are high, with both complications associated with a poor prognosis. Our observations emphasize the need for prospective studies to determine optimal thromboprophylaxis and VTE treatment strategy in these patients.
To cite this abstract in AMA style:Kaptein FHJ, Stals MAM, Klaase E, Kapteijn MY, van Eijk R, Cannegieter SC, van Duinen SG, Taphoorn MJB, Dirven L, Versteeg HH, Buijs JT, Huisman MV, Koekkoek JAF, Klok FA. Incidence and Impact of Venous Thromboembolism and Major Bleeding in Patients with Glioblastoma [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/incidence-and-impact-of-venous-thromboembolism-and-major-bleeding-in-patients-with-glioblastoma/. Accessed September 23, 2021.
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