Thromboembolism in patients with high-grade glioma

J. F. Quevedo, Jan Craig Buckner, J. L. Schmidt, R. P. Dinapoli, J. R. O'Fallon

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Abstract

Objective: To identify factors related to increased or decreased risk of thromboembolism (TE) in patients with high-grade glioma. Design: We performed a retrospective analysis of 64 patients enrolled in two prospective clinical trials of chemotherapy and radiation therapy for newly diagnosed high-grade glioma. Material and Methods: The 64 patients were 18 years of age or older and had histologically confirmed grade 3 or 4 astrocytoma, mixed astrocytoma- oligodendroglioma, or gliosarcoma. The diagnosis of TE was confirmed by impedance plethysmography, venography, duplex ultrasonography, ventilation- perfusion lung scanning, or pulmonary angiography. For statistical analysis, the study group was divided into those with and those without TE. Results: TE developed in 18 of the 64 patients (28%). Of the 18 patients, 11 had deep venous thrombosis of a lower extremity, 5 had pulmonary emboli, and 2 had superficial thrombophlebitis. A paretic arm (P = 0.017), a paretic leg (P = 0.026), or a history of TE before the diagnosis of glioma (P = 0.076) was more common in patients with TE than in those without TE. Ten patients in the group without TE were using aspirin preoperatively in comparison with no patient in the TE group (P = 0.05). No significant differences were noted in duration of survival (median, 39.4 weeks and 46 weeks for the TE and non-TE groups, respectively). One patient with apparently excessive anticoagulation had a fatal intracerebral hemorrhage. Conclusion: This study suggests that TE in patients with newly diagnosed high-grade glioma might be associated with a history of TE or with a paretic extremity; however, no evidence of worse survival was noted in the TE group. Treatment with heparin followed by warfarin sodium was associated with infrequent bleeding complications. An intriguing finding was that the use of aspirin before operation was associated with a decreased risk of TE. Thus, a prospective study with use of aspirin in patients with high-grade glioma at risk for TE would be reasonable.

Original languageEnglish (US)
Pages (from-to)329-332
Number of pages4
JournalMayo Clinic Proceedings
Volume69
Issue number4
StatePublished - 1994

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Thromboembolism
Glioma
Aspirin
Lung
Gliosarcoma
Impedance Plethysmography
Oligodendroglioma
Thrombophlebitis
Survival
Phlebography
Astrocytoma
Cerebral Hemorrhage
Warfarin
Embolism
Venous Thrombosis
Ventilation
Heparin
Lower Extremity
Ultrasonography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Quevedo, J. F., Buckner, J. C., Schmidt, J. L., Dinapoli, R. P., & O'Fallon, J. R. (1994). Thromboembolism in patients with high-grade glioma. Mayo Clinic Proceedings, 69(4), 329-332.

Thromboembolism in patients with high-grade glioma. / Quevedo, J. F.; Buckner, Jan Craig; Schmidt, J. L.; Dinapoli, R. P.; O'Fallon, J. R.

In: Mayo Clinic Proceedings, Vol. 69, No. 4, 1994, p. 329-332.

Research output: Contribution to journalArticle

Quevedo, JF, Buckner, JC, Schmidt, JL, Dinapoli, RP & O'Fallon, JR 1994, 'Thromboembolism in patients with high-grade glioma', Mayo Clinic Proceedings, vol. 69, no. 4, pp. 329-332.
Quevedo JF, Buckner JC, Schmidt JL, Dinapoli RP, O'Fallon JR. Thromboembolism in patients with high-grade glioma. Mayo Clinic Proceedings. 1994;69(4):329-332.
Quevedo, J. F. ; Buckner, Jan Craig ; Schmidt, J. L. ; Dinapoli, R. P. ; O'Fallon, J. R. / Thromboembolism in patients with high-grade glioma. In: Mayo Clinic Proceedings. 1994 ; Vol. 69, No. 4. pp. 329-332.
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abstract = "Objective: To identify factors related to increased or decreased risk of thromboembolism (TE) in patients with high-grade glioma. Design: We performed a retrospective analysis of 64 patients enrolled in two prospective clinical trials of chemotherapy and radiation therapy for newly diagnosed high-grade glioma. Material and Methods: The 64 patients were 18 years of age or older and had histologically confirmed grade 3 or 4 astrocytoma, mixed astrocytoma- oligodendroglioma, or gliosarcoma. The diagnosis of TE was confirmed by impedance plethysmography, venography, duplex ultrasonography, ventilation- perfusion lung scanning, or pulmonary angiography. For statistical analysis, the study group was divided into those with and those without TE. Results: TE developed in 18 of the 64 patients (28{\%}). Of the 18 patients, 11 had deep venous thrombosis of a lower extremity, 5 had pulmonary emboli, and 2 had superficial thrombophlebitis. A paretic arm (P = 0.017), a paretic leg (P = 0.026), or a history of TE before the diagnosis of glioma (P = 0.076) was more common in patients with TE than in those without TE. Ten patients in the group without TE were using aspirin preoperatively in comparison with no patient in the TE group (P = 0.05). No significant differences were noted in duration of survival (median, 39.4 weeks and 46 weeks for the TE and non-TE groups, respectively). One patient with apparently excessive anticoagulation had a fatal intracerebral hemorrhage. Conclusion: This study suggests that TE in patients with newly diagnosed high-grade glioma might be associated with a history of TE or with a paretic extremity; however, no evidence of worse survival was noted in the TE group. Treatment with heparin followed by warfarin sodium was associated with infrequent bleeding complications. An intriguing finding was that the use of aspirin before operation was associated with a decreased risk of TE. Thus, a prospective study with use of aspirin in patients with high-grade glioma at risk for TE would be reasonable.",
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AU - Quevedo, J. F.

AU - Buckner, Jan Craig

AU - Schmidt, J. L.

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AU - O'Fallon, J. R.

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N2 - Objective: To identify factors related to increased or decreased risk of thromboembolism (TE) in patients with high-grade glioma. Design: We performed a retrospective analysis of 64 patients enrolled in two prospective clinical trials of chemotherapy and radiation therapy for newly diagnosed high-grade glioma. Material and Methods: The 64 patients were 18 years of age or older and had histologically confirmed grade 3 or 4 astrocytoma, mixed astrocytoma- oligodendroglioma, or gliosarcoma. The diagnosis of TE was confirmed by impedance plethysmography, venography, duplex ultrasonography, ventilation- perfusion lung scanning, or pulmonary angiography. For statistical analysis, the study group was divided into those with and those without TE. Results: TE developed in 18 of the 64 patients (28%). Of the 18 patients, 11 had deep venous thrombosis of a lower extremity, 5 had pulmonary emboli, and 2 had superficial thrombophlebitis. A paretic arm (P = 0.017), a paretic leg (P = 0.026), or a history of TE before the diagnosis of glioma (P = 0.076) was more common in patients with TE than in those without TE. Ten patients in the group without TE were using aspirin preoperatively in comparison with no patient in the TE group (P = 0.05). No significant differences were noted in duration of survival (median, 39.4 weeks and 46 weeks for the TE and non-TE groups, respectively). One patient with apparently excessive anticoagulation had a fatal intracerebral hemorrhage. Conclusion: This study suggests that TE in patients with newly diagnosed high-grade glioma might be associated with a history of TE or with a paretic extremity; however, no evidence of worse survival was noted in the TE group. Treatment with heparin followed by warfarin sodium was associated with infrequent bleeding complications. An intriguing finding was that the use of aspirin before operation was associated with a decreased risk of TE. Thus, a prospective study with use of aspirin in patients with high-grade glioma at risk for TE would be reasonable.

AB - Objective: To identify factors related to increased or decreased risk of thromboembolism (TE) in patients with high-grade glioma. Design: We performed a retrospective analysis of 64 patients enrolled in two prospective clinical trials of chemotherapy and radiation therapy for newly diagnosed high-grade glioma. Material and Methods: The 64 patients were 18 years of age or older and had histologically confirmed grade 3 or 4 astrocytoma, mixed astrocytoma- oligodendroglioma, or gliosarcoma. The diagnosis of TE was confirmed by impedance plethysmography, venography, duplex ultrasonography, ventilation- perfusion lung scanning, or pulmonary angiography. For statistical analysis, the study group was divided into those with and those without TE. Results: TE developed in 18 of the 64 patients (28%). Of the 18 patients, 11 had deep venous thrombosis of a lower extremity, 5 had pulmonary emboli, and 2 had superficial thrombophlebitis. A paretic arm (P = 0.017), a paretic leg (P = 0.026), or a history of TE before the diagnosis of glioma (P = 0.076) was more common in patients with TE than in those without TE. Ten patients in the group without TE were using aspirin preoperatively in comparison with no patient in the TE group (P = 0.05). No significant differences were noted in duration of survival (median, 39.4 weeks and 46 weeks for the TE and non-TE groups, respectively). One patient with apparently excessive anticoagulation had a fatal intracerebral hemorrhage. Conclusion: This study suggests that TE in patients with newly diagnosed high-grade glioma might be associated with a history of TE or with a paretic extremity; however, no evidence of worse survival was noted in the TE group. Treatment with heparin followed by warfarin sodium was associated with infrequent bleeding complications. An intriguing finding was that the use of aspirin before operation was associated with a decreased risk of TE. Thus, a prospective study with use of aspirin in patients with high-grade glioma at risk for TE would be reasonable.

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