PB1434 - Brain tumours receiving anticoagulants: pre-existing haemorrhagic component and risk of ICH

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

FH

Farzana Haque

Clinical Lecturer
Division of Cancer, Hull-York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
Hull, England, United Kingdom

Co-Author(s)

SZ

Saira Zafar

Medical registrar
Hull University Teaching Hospital NHS Trust
Hull, England, United Kingdom
NP

Nicoleta Pahomi

Senior House Officer
Hull University Teaching Hospital NHS Trust
Hull, England, United Kingdom
AH

Ashraful Huda

General Practitioner
Hull University Teaching Hospital NHS Trust
Hull, England, United Kingdom
SS

Silmi Shahama

Senior House Officer
Hull University Teaching Hospital NHS Trust
Hull, England, United Kingdom
ST

Sharmin Tuly

Senior House Officer
Hull University Teaching Hospital NHS Trust
Hull, England, United Kingdom
GA

Ged Avery

Professor and consultant Radiologist
Hull University Teaching Hospital NHS Trust
Hull, England, United Kingdom
AM

Anthony Maraveyas

Professor of Oncology
Division of Cancer, Hull-York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
Hull, England, United Kingdom

Background: An increased risk of intracranial haemorrhage (ICH) is associated with anticoagulation (AC), as compared with no-AC in patients with high-grade glioma, melanoma(MM) and renal cell carcinoma(RCC). Although multiple risk factors have been studied, including the PANWARDS score and type of AC, association with the risk of ICH has not been demonstrated. Despite angiogenic drivers being different in these malignancies, they commonly have pre-existing haemorrhagic components (PHC) on imaging. The contribution of PHC to the risk of ICH in the presence of AC has not been studied to date.

Aims: In this single-centre cohort study, we aim to categorise PHC and assess its contribution to the risk of subsequent ICH.

Methods: 329 patients with a CNS malignancy receiving AC from 2012 to 2022 were included in the study (Audit number 2020.158). SPSS v29, IBM Corp ™ was used for statistical analysis.

Results: 55.3% (182/329) were male. Median age 67 years (range 27-91). Median follow-up from initiation of AC 8.9 months. 43.8% had primary CNS tumours. 14.9% of patients had PHC. The majority (87.7%) of patients were prescribed AC for venous thromboembolism (VTE), and the rest for atrial fibrillation. 45.6% received direct oral anticoagulants (DOACs), 49.5% low molecular weight heparin (LMWH) and 5% Warfarin. 25.2% (83/329) had various grades of ICH (half ABC technique), of which 30.1% (25/83) had evidence of PHC prior to initiating anticoagulation. A chi-square test of independence showed a significant association between PHC and ICH, X2 (1, N = 323) = 20.7, p = < 0.001.

Conclusion(s): Almost a third of patients who developed an ICH had PHC in their CNS lesions before commencing anticoagulants. A multivariate analysis of previously described risk factors for ICH [type of cancers, treatment groups (LMWH Vs DOAC), patient characteristics, etc.] in patients with or without PHC on the risk of developing ICH will be presented.