D-dimer elevation and paresis predict thromboembolic events during bevacizumab therapy for recurrent malignant glioma.

Abstract:

BACKGROUND:The major side-effects of bevacizumab in glioma treatment are venous thromboembolic events (VTE). We retrospectively evaluated factors potentially predictive of thromboembolic events. PATIENTS AND METHODS:Bevacizumab, alone or in combination with chemotherapy was used as salvage therapy for recurrence in malignant glioma every two weeks. None but one patient received anti-coagulants. Before each bevacizumab cycle differential blood cell count, kidney and liver parameters, D-dimers, neurological status, body-mass index, vital signs and signs of venous thrombosis were assessed. RESULTS:Thirty-eight patients received 428 cycles of bevacizumab. In five patients (13%), six VTE were observed. These complications were preceded four weeks before the onset of symptoms by D-dimer elevation above 0.865 mg/l [p<0.0001; sensitivity=89% (95% confidence interval=83-93%); specificity=89% (95% CI=52-100%)]. An existing hemiparesis constituted a 27-fold risk elevation for thrombotic complication (p<0.0001, χ(2)-test). CONCLUSION:D-Dimer elevation or hemiparesis predict VTE under bevacizumab and chemotherapy, four weeks before the event becomes clinically apparent. Future investigations should determine if prophylactic anti-coagulants for patients at risk may reduce the risk of VTE.

journal_name

Anticancer Res

journal_title

Anticancer research

authors

Misch M,Czabanka M,Dengler J,Stoffels M,Auf G,Vajkoczy P,Stockhammer F

subject

Has Abstract

pub_date

2013-05-01 00:00:00

pages

2093-8

issue

5

eissn

0250-7005

issn

1791-7530

pii

33/5/2093

journal_volume

33

pub_type

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