Introduction

Venous thromboembolism (VTE) is a known complication of malignancy. While brain tumors in general predispose to VTE, the incidence in primary central nervous system lymphoma (PCNSL) is poorly characterized. We sought to characterize incidence, risk factors, management, and outcome of VTE in PCNSL

Method

Retrospective study of 78 PCNSL patients from 2/1/2002 to 4/1/2020 at the University of Virginia

Results

31% (24/78) of patients developed VTE. 12.8% (10/78) had deep venous thrombosis (DVT) alone, 11.5% (9/78) isolated pulmonary embolism (PE) and 6.4% (5/78) both. The median time from PCNSL diagnosis to VTE was 2 months. In a univariate competing risks analysis, previous VTE (p < 0.001), impaired ambulation (p = 0.035), baseline hemoglobin < 10 g/dL (p = 0.025) and history of diabetes mellitus (p = 0.007) were associated with increased VTE risk. 34.8% were anticoagulated acutely with heparin (8/23) or 65.2% LMWH (15/23), and 25.0% (6/24) received warfarin, 41.7% (10/24) LMWH, and 33.3% (8/24) DOACs long-term. One adverse event was attributable to anticoagulation (arm hematoma with hemoglobin decrease). Five patients received IVC filters with concomitant oral anticoagulation; one experienced IVC thrombosis after anticoagulation discontinuation. Six of the 24 patients experienced recurrent VTE, four while anticoagulated.

Conclusion

Patients with PCNSL are at high risk of VTE, most of which accrues in the first few months. History of VTE, diabetes mellitus, impaired ambulatory status, or hemoglobin < 10 mg/dL may predispose patients to this complication. While optimal management is uncertain, anticoagulation prevented recurrent VTE in most patients without intracranial bleeding.

中文翻译：

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原发性中枢神经系统淋巴瘤患者静脉血栓栓塞的发生率、危险因素和治疗

介绍

静脉血栓栓塞症 (VTE) 是一种已知的恶性肿瘤并发症。虽然脑肿瘤通常易患 VTE，但原发性中枢神经系统淋巴瘤 (PCNSL) 的发病率尚不明确。我们试图描述 PCNSL 中 VTE 的发生率、风险因素、管理和结果

方法

弗吉尼亚大学 2002 年 2 月 1 日至 2020 年 4 月 1 日对 78 名 PCNSL 患者的回顾性研究

结果

31% (24/78) 的患者发生 VTE。12.8% (10/78) 仅有深静脉血栓形成 (DVT)，11.5% (9/78) 有单纯性肺栓塞 (PE)，6.4% (5/78) 两者均有。从 PCNSL 诊断到 VTE 的中位时间为 2 个月。在单变量竞争风险分析中，既往 VTE (p < 0.001)、行走障碍 (p = 0.035)、基线血红蛋白 < 10 g/dL (p = 0.025) 和糖尿病史 (p = 0.007) 与 VTE 增加有关风险。34.8% 用肝素 (8/23) 或 65.2% LMWH (15/23) 进行急性抗凝，25.0% (6/24) 接受华法林，41.7% (10/24) LMWH 和 33.3% (8/24) DOACs 长期。一项不良事件可归因于抗凝（手臂血肿伴血红蛋白减少）。5 名患者接受 IVC 过滤器并同时口服抗凝剂；一名患者在停用抗凝剂后出现 IVC 血栓形成。

结论

PCNSL 患者发生 VTE 的风险很高，其中大部分发生在最初几个月。静脉血栓栓塞病史、糖尿病、行走状态受损或血红蛋白 < 10 mg/dL 可能使患者易患此并发症。虽然最佳治疗尚不确定，但抗凝治疗可预防大多数无颅内出血患者的 VTE 复发。