newly diagnosed malignant glioma was assessed in the PRODIGE trial [5]. The trial was terminated prematurely because of the unavailability of placebo. Overall, 186 patients were randomly assigned to six months of treatment with dalteparin or placebo, with an option to continue on study medication for up to 12 months. The incidence of clinically evident VTE at six months was lower among those receiving dalteparin (11 versus 17 percent with placebo), but the difference was not statistically significant. Intracranial hemorrhages were more common in patients treated with dalteparin (5 versus 1 percent with placebo at 12 months; hazard ratio [HR] 4.2, 95% CI 0.48-36). The PRODIGE trial confirmed the substantial risk of VTE in patients with malignant gliomas. Although there were trends toward reduction of VTE and increase in intracranial hemorrhage, the trial did not have adequate statistic power at the time of termination to draw definitive conclusions about the benefits versus risks of long-term anticoagulation. A small phase II trial involving 40 patients with malignant gliomas treated with the LMW heparin tinzaparin 4500 international units subcutaneously daily for a median of approximately five months reported symptomatic central nervous system (CNS) hemorrhage in one patient (2.5 percent) and deep vein thrombosis (DVT) in one patient (2.5 percent) [62]. For the prevention of VTE in at-risk patients with brain tumors, long-term treatment with daily aspirin (eg, 325 mg/day orally) may offer partial protection and is easy to administer, although neither the safety nor efficacy of this approach has been well defined in this population [40]. For general VTE prevention, aspirin appears to have some activity, but it is clearly less than that afforded by anticoagulation [63]. (See "Selecting adult patients with lower extremity deep venous thrombosis and pulmonary embolism for indefinite anticoagulation".) Aspirin therapy may be considered for primary prevention of VTE in brain tumor patients who are 60 years old, have large tumors or substantial leg weakness, or are undergoing chemotherapy. However, the effect of aspirin in inhibiting platelet function in patients at risk for chemotherapy-induced thrombocytopenia must be weighed against the limited evidence of benefit in preventing VTE. https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 12/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate SOCIETY GUIDELINE LINKS Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Anticoagulation" and "Society guideline links: Primary brain tumors".) INFORMATION FOR PATIENTS UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." th th The Basics patient education pieces are written in plain language, at the 5 to 6 grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more th th sophisticated, and more detailed. These articles are written at the 10 to 12 grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.) Beyond the Basics topics (see "Patient education: Warfarin (Beyond the Basics)" and "Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)") SUMMARY AND RECOMMENDATIONS General principles The general principles of managing acute venous thromboembolism (VTE) in patients with brain tumors are the same as in other patients with and without cancer. Anticoagulation is the cornerstone of treatment, and treatment decisions balance the risk of bleeding complications due to anticoagulation with the risks of untreated and recurrent VTE. (See 'Introduction' above.) Pretreatment risk assessment The risk of bleeding in patients with brain tumors is determined by considering both general risk factors for bleeding with anticoagulant therapy ( table 2 and table 1) and risk of intracranial hemorrhage related to the tumor and any antitumor therapies. (See 'Pre-anticoagulation risk assessment' above.) https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 13/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate Absolute contraindications to anticoagulation in patients with and without brain tumors include acute intracranial hemorrhage (<48 hours), uncontrolled malignant hypertension, severe coagulopathy, severe platelet dysfunction or thrombocytopenia, inherited bleeding disorder, and recent intracranial surgery. (See 'Absolute contraindications' above.) Therapeutic anticoagulation Most brain tumors do not pose a prohibitive risk of hemorrhage in patients with VTE who are otherwise appropriate candidates for anticoagulation. Potential exceptions include brain metastases from melanoma, choriocarcinoma, thyroid carcinoma, and renal cell carcinoma, which have a higher rate of spontaneous intratumoral hemorrhage than other tumor types, and patients with a history of intratumoral hemorrhage. Decisions in these patients should be individualized. (See 'Relative contraindications' above.) Agent selection In patients with brain tumors who are selected to receive anticoagulation for VTE, we suggest a direct oral anticoagulant (DOAC) rather than low molecular weight (LMW) heparin or warfarin (Grade 2C). For patients who cannot take a DOAC due to cost, we suggest LMW heparin rather than warfarin for maintenance (Grade 2C). For patients with severe renal insufficiency, options include renally-dosed LMW heparin with monitoring of anti-factor Xa activity or warfarin. (See 'Agent selection' above.) Duration VTE in low-grade glioma and benign tumors should be treated for three to six months, whereas long-term anticoagulation is generally indicated for patients with glioblastoma and other active malignancies. (See 'Duration of therapy' above.) Role of inferior vena cava (IVC) filter IVC filters should not be routinely inserted in brain tumor patients with acute deep vein thrombosis (DVT). However, they remain in use for patients deemed to have a prohibitive risk of bleeding with anticoagulation and life- threatening thrombus burden. (See 'Role of inferior vena cava filter' above.) Prophylactic anticoagulation Although patients with primary or metastatic brain tumors are at relatively high risk for the development of VTE, we suggest that these patients not be anticoagulated prophylactically, except in the postoperative period (Grade 2B). (See 'Primary prevention (VTE prophylaxis)' above.) Use of UpToDate is subject to the Terms of Use. REFERENCES https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 14/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate 1. Key NS, Khorana AA, Kuderer NM, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol 2020; 38:496. 2. Farge D, Debourdeau P, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 2013; 11:56. 3. Khorana AA, Noble S, Lee AYY, et al. Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost 2018; 16:1891. 4. NCCN guidelines on cancer-associated venous thromboembolic disease. https://www.nccn.o rg/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pd f/vte.pdf. 5. Perry JR, Julian JA, Laperriere NJ, et al. PRODIGE: a randomized placebo-controlled trial of dalteparin low-molecular-weight heparin thromboprophylaxis in patients with newly diagnosed malignant glioma. J Thromb Haemost 2010; 8:1959. 6. Ruff RL, Posner JB. Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol 1983; 13:334. 7. Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery 1982; 10:437. 8. Chinot OL, Wick W, Mason W, et al. Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med 2014; 370:709. 9. Jo J, Donahue J, Sarai G, et al. Management of venous thromboembolism in high-grade glioma: Does low molecular weight heparin increase intracranial bleeding risk? Neuro Oncol 2022; 24:455. 10. Mandybur TI. Intracranial hemorrhage caused by metastatic tumors. Neurology 1977; 27:650. 11. Donato J, Campigotto F, Uhlmann EJ, et al. Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study. Blood 2015; 126:494. 12. Poon MT, Fonville AF, Al-Shahi Salman R. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2014; 85:660. 13. Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 15/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate American Heart Association/American Stroke Association. Stroke 2015; 46:2032. 14. Nghiemphu PL, Green RM, Pope WB, et al. Safety of anticoagulation use and bevacizumab in patients with glioma. Neuro Oncol 2008; 10:355. 15. Norden AD, Bartolomeo J, Tanaka S, et al. Safety of concurrent bevacizumab therapy and anticoagulation in glioma patients. J Neurooncol 2012; 106:121. 16. Misch M, Czabanka M, Dengler J, et al. D-dimer elevation and paresis predict thromboembolic events during bevacizumab therapy for recurrent malignant glioma. Anticancer Res 2013; 33:2093. 17. Levin JM, Schiff D, Loeffler JS, et al. Complications of therapy for venous thromboembolic disease in patients with brain tumors. Neurology 1993; 43:1111. 18. Olin JW, Young JR, Graor RA, et al. Treatment of deep vein thrombosis and pulmonary emboli in patients with primary and metastatic brain tumors. Anticoagulants or inferior vena cava filter? Arch Intern Med 1987; 147:2177. 19. Wen PY, Marks PW. Medical management of patients with brain tumors. Curr Opin Oncol 2002; 14:299. 20. Norris LK, Grossman SA. Treatment of thromboembolic complications in patients with brain tumors. J Neurooncol 1994; 22:127. 21. Zwicker JI, Karp Leaf R, Carrier M. A meta-analysis of intracranial hemorrhage in patients with brain tumors receiving therapeutic anticoagulation. J Thromb Haemost 2016; 14:1736. 22. Wood P, Boyer G, Mehanna E, et al. Intracerebral haemorrhage in patients with brain metastases receiving therapeutic anticoagulation. J Neurol Neurosurg Psychiatry 2021. 23. Riedl J, Ay C. Venous Thromboembolism in Brain Tumors: Risk Factors, Molecular Mechanisms, and Clinical Challenges. Semin Thromb Hemost 2019; 45:334. 24. Carney BJ, Uhlmann EJ, Puligandla M, et al. Intracranial hemorrhage with direct oral anticoagulants in patients with brain tumors. J Thromb Haemost 2019; 17:72. 25. Leader A, Hamuly k EN, Carney BJ, et al. Intracranial hemorrhage with direct oral anticoagulants in patients with brain metastases. Blood Adv 2020; 4:6291. 26. Swartz AW, Drappatz J. Safety of Direct Oral Anticoagulants in Central Nervous System Malignancies. Oncologist 2021; 26:427. 27. Reed-Guy L, Desai AS, Phillips RE, et al. Risk of intracranial hemorrhage with direct oral anticoagulants vs low molecular weight heparin in glioblastoma: A retrospective cohort study. Neuro Oncol 2022; 24:2172. 28. Giustozzi M, Proietti G, Becattini C, et al. ICH in primary or metastatic brain cancer patients with or without anticoagulant treatment: a systematic review and meta-analysis. Blood Adv https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 16/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate 2022; 6:4873. 29. Giustozzi M, Becattini C, Roila F, et al. DOACs in patients with brain cancers: promising but still a long way to go. Blood Adv 2023; 7:283. 30. Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med 2018; 378:615. 31. Young AM, Marshall A, Thirlwall J, et al. Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). J Clin Oncol 2018; 36:2017. 32. McBane RD 2nd, Wysokinski WE, Le-Rademacher JG, et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: The ADAM VTE trial. J Thromb Haemost 2020; 18:411. 33. Agnelli G, Becattini C, Meyer G, et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. N Engl J Med 2020; 382:1599. 34. Chai-Adisaksopha C, Linkins LA, ALKindi SY, et al. Outcomes of low-molecular-weight heparin treatment for venous thromboembolism in patients with primary and metastatic brain tumours. Thromb Haemost 2017; 117:589. 35. Yust-Katz S, Mandel JJ, Wu J, et al. Venous thromboembolism (VTE) and glioblastoma. J Neurooncol 2015; 124:87. 36. Mantia C, Uhlmann EJ, Puligandla M, et al. Predicting the higher rate of intracranial hemorrhage in glioma patients receiving therapeutic enoxaparin. Blood 2017; 129:3379. 37. Schiff D, DeAngelis LM. Therapy of venous thromboembolism in patients with brain metastases. Cancer 1994; 73:493. 38. Choucair AK, Silver P, Levin VA. Risk of intracranial hemorrhage in glioma patients receiving anticoagulant therapy for venous thromboembolism. J Neurosurg 1987; 66:357. 39. Altschuler E, Moosa H, Selker RG, Vertosick FT Jr. The risk and efficacy of anticoagulant therapy in the treatment of thromboembolic complications in patients with primary malignant brain tumors. Neurosurgery 1990; 27:74. 40. Quevedo JF, Buckner JC, Schmidt JL, et al. Thromboembolism in patients with high-grade glioma. Mayo Clin Proc 1994; 69:329. 41. Edwin NC, Khoury MN, Sohal D, et al. Recurrent venous thromboembolism in glioblastoma. Thromb Res 2016; 137:184. 42. Gerber DE, Grossman SA, Streiff MB. Management of venous thromboembolism in patients with primary and metastatic brain tumors. J Clin Oncol 2006; 24:1310. https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 17/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate 43. Semrad TJ, O'Donnell R, Wun T, et al. Epidemiology of venous thromboembolism in 9489 patients with malignant glioma. J Neurosurg 2007; 106:601. 44. Jenkins EO, Schiff D, Mackman N, Key NS. Venous thromboembolism in malignant gliomas. J Thromb Haemost 2010; 8:221. 45. Perry JR. Thromboembolic disease in patients with high-grade glioma. Neuro Oncol 2012; 14 Suppl 4:iv73. 46. Ay C, Vormittag R, Dunkler D, et al. D-dimer and prothrombin fragment 1 + 2 predict venous thromboembolism in patients with cancer: results from the Vienna Cancer and Thrombosis Study. J Clin Oncol 2009; 27:4124. 47. Brandes AA, Scelzi E, Salmistraro G, et al. Incidence of risk of thromboembolism during treatment high-grade gliomas: a prospective study. Eur J Cancer 1997; 33:1592. 48. Streiff MB, Ye X, Kickler TS, et al. A prospective multicenter study of venous thromboembolism in patients with newly-diagnosed high-grade glioma: hazard rate and risk factors. J Neurooncol 2015; 124:299. 49. Streiff MB, Segal J, Grossman SA, et al. ABO blood group is a potent risk factor for venous thromboembolism in patients with malignant gliomas. Cancer 2004; 100:1717. 50. Mir Seyed Nazari P, Riedl J, Preusser M, et al. Combination of isocitrate dehydrogenase 1 (IDH1) mutation and podoplanin expression in brain tumors identifies patients at high or low risk of venous thromboembolism. J Thromb Haemost 2018; 16:1121. 51. Diaz M, Jo J, Smolkin M, et al. Risk of Venous Thromboembolism in Grade II-IV Gliomas as a Function of Molecular Subtype. Neurology 2021; 96:e1063. 52. Burdett KB, Unruh D, Drumm M, et al. Determining venous thromboembolism risk in patients with adult-type diffuse glioma. Blood 2023; 141:1322. 53. Burdett, Kristen Bell. VTE Prediction for Patients with Glioma. 2022. Available at: https://kbell burdett.shinyapps.io/GliomaPredictVTE/ (Accessed on May 04, 2023). 54. Chan AT, Atiemo A, Diran LK, et al. Venous thromboembolism occurs frequently in patients undergoing brain tumor surgery despite prophylaxis. J Thromb Thrombolysis 1999; 8:139. 55. Smith TR, Lall RR, Graham RB, et al. Venous thromboembolism in high grade glioma among surgical patients: results from a single center over a 10 year period. J Neurooncol 2014; 120:347. 56. Agnelli G, Piovella F, Buoncristiani P, et al. Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 1998; 339:80. https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 18/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate 57. Iorio A, Agnelli G. Low-molecular-weight and unfractionated heparin for prevention of venous thromboembolism in neurosurgery: a meta-analysis. Arch Intern Med 2000; 160:2327. 58. Constantini S, Kanner A, Friedman A, et al. Safety of perioperative minidose heparin in patients undergoing brain tumor surgery: a prospective, randomized, double-blind study. J Neurosurg 2001; 94:918. 59. Alshehri N, Cote DJ, Hulou MM, et al. Venous thromboembolism prophylaxis in brain tumor patients undergoing craniotomy: a meta-analysis. J Neurooncol 2016; 130:561. 60. Khan NR, Patel PG, Sharpe JP, et al. Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis. J Neurosurg 2018; 129:906. 61. Schmidt F, Faul C, Dichgans J, Weller M. Low molecular weight heparin for deep vein thrombosis in glioma patients. J Neurol 2002; 249:1409. 62. Perry SL, Bohlin C, Reardon DA, et al. Tinzaparin prophylaxis against venous thromboembolic complications in brain tumor patients. J Neurooncol 2009; 95:129. 63. Hovens MM, Snoep JD, Tamsma JT, Huisman MV. Aspirin in the prevention and treatment of venous thromboembolism. J Thromb Haemost 2006; 4:1470. Topic 5201 Version 45.0 https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 19/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate GRAPHICS Issues to be considered when making decisions concerning the use or non- use of anticoagulation in patients with malignancy Overall treatment plan and prognosis Therapeutic goal (eg, palliation of symptoms related to VTE, planned oncologic intervention, immediate prognosis, hospice care) Planned chemotherapy Stage of the malignancy, overall prognosis Other causes for hypercoagulability (eg, bedridden, pathologic fracture, recent surgery or invasive procedures, use of hormonal agents or other medications with a high incidence of thrombotic side effects, presence of a central venous access line) Patient preferences, logistic, and financial issues Inpatient or outpatient care planned Who will supervise medication's use and required monitoring, if any? Patient preferences (eg, oral versus injectable agent, need for frequent monitoring of coagulation status) Treatment costs; Will the patient's insurance pay for the medication? Relative contraindications to anticoagulation Presence of central nervous system involvement Central nervous system primary or metastases Prior intracerebral hemorrhage Thrombocytopenia or bleeding diathesis present? Are risk factors for bleeding after use of warfarin present? (eg, impaired liver function, hepatic metastases, concomitant medication, poor nutrition) Selection of appropriate dosing (eg, impaired renal function, obesity, advanced age) Need for monitoring of treatment (eg, INR for treatment with warfarin) Ability or inability to reverse anticoagulation if bleeding occurs VTE: venous thromboembolism; INR: international normalized ratio. Graphic 81646 Version 7.0 https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 20/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate Risk factors for bleeding with anticoagulant therapy and estimated risk of major bleeding in low, moderate, and high risk categories Risk factors* Age >65 years Age >75 years Previous bleeding Cancer Metastatic cancer Renal failure Liver failure Thrombocytopenia Previous stroke Diabetes Anemia Antiplatelet therapy Poor anticoagulant control Comorbidity and reduced functional capacity Recent surgery Frequent falls Alcohol abuse Estimated absolute risk of major bleeding (%) Categorization Low risk Moderate risk High risk ( 2 risk factors) of risk of bleeding (0 risk factors) (1 risk factor) Anticoagulation 0 to 3 months Baseline risk (%) 0.6 1.2 4.8 Increased risk (%) 1 2 8 Total risk (%) 1.6 3.2 12.8 Anticoagulation after first 3 months 2.5 Baseline risk (%/years) 0.3 0.6 4 Increased risk (%/years) 0.5 1 6.5 Total risk (%/years) 0.8** 1.6** GI: gastrointestinal; UFH: unfractionated heparin; LMWH: low molecular weight heparin; VKA: vitamin K-dependent antagonist (ie, warfarin); VTE: venous thromboembolism. https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 21/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate The increase in bleeding associated with a risk factor will vary with (1) severity of the risk factor (eg, location and extent of metastatic disease, platelet count), (2) temporal relationships (eg, interval from surgery or a previous bleeding episode), and (3) how effectively a previous cause of bleeding was corrected (eg, upper-GI bleeding). Important for parenteral anticoagulation (eg, first 10 days), but less important for long-term or extended anticoagulation. Although there is evidence that risk of bleeding increases with the prevalence of risk factors, this categorization scheme has not been validated. Furthermore, a single risk factor, when severe, will result in a high risk of bleeding (eg, major surgery within the past 2 days, severe thrombocytopenia). Compared with low-risk patients, moderate-risk patients are assumed to have a 2-fold risk and high-risk patients an 8-fold risk of major bleeding. The 1.6% corresponds to the average of major bleeding with initial UFH or LMWH therapy followed by VKA therapy. We estimated baseline risk by assuming a 2.6 relative risk of major bleeding with anticoagulation (refer to footnote ). [1] Consistent with frequency of major bleeding observed by Hull et al in high-risk patients . We estimate that anticoagulation is associated with a 2.6-fold increase in major bleeding based on comparison of extended anticoagulation with no extended anticoagulation. The relative risk of major bleeding during the first 3 months of therapy may be greater than during extended VKA therapy because (1) the intensity of anticoagulation with initial parenteral therapy may be greater than with VKA therapy; (2) anticoagulant control will be less stable during the first 3 months; and (3) predispositions to anticoagulant-induced bleeding may be uncovered during the first 3 months of therapy. However, studies of patients with acute coronary syndromes do not suggest a 2.6 relative risk of major bleeding with parenteral anticoagulation (eg, UFH or LMWH) compared with control. Our estimated baseline risk of major bleeding for low-risk patients (and adjusted up for moderate- and high-risk groups as per footnote ). * Consistent with frequency of major bleeding during prospective studies of extended anticoagulation for VTE. Reference: 1. Hull RD, Raskob GE, Rosenbloom D, et al. Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. N Engl J Med 1990; 322:1260. Reproduced from: Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e419S. Table used with the permission of Elsevier Inc. All rights reserved. Graphic 97160 Version 5.0 https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 22/23 7/6/23, 1:01 PM Treatment and prevention of venous thromboembolism in patients with brain tumors - UpToDate Contributor Disclosures Eudocia Quant Lee, MD, MPH Consultant/Advisory Boards: Medscape [Brain tumors]. Other Financial Interest: MedLink [Neurologic complications of cancer therapy]. All of the relevant financial relationships listed have been mitigated. Patrick Y Wen, MD Grant/Research/Clinical Trial Support: Agios Pharmaceuticals [Brain tumor]; AstraZeneca/MedImmune [Brain tumor]; Bayer [Brain tumor]; BeiGene [Brain tumor]; Bristol Meyers Squibb [Brain tumor]; Celgene [Brain tumor]; Chimerix [Brain tumor]; Eli Lilly [Brain tumor]; Kazia [Brain tumor]; MediciNova [Brain tumor]; Merck [Brain tumor]; Novartis [Brain tumor]; Nuvation Bio [Brain tumor]; Oncoceutics [Brain tumor]; Puma [Brain tumor]; Servier [Brain tumor]; Vascular Biogenics [Brain tumor]; VBI Vaccines [Brain tumor]. Consultant/Advisory Boards: AstraZeneca [Brain tumor]; Bayer [Brain tumor]; Black Diamond [Brain tumor]; Boston Pharmaceuticals [Brain tumor]; Celularity [Brain tumor]; Chimerix [Brain tumor]; Day One Bio [Brain tumor]; Genenta [Brain tumor]; Glaxo Smith Kline [Brain tumor]; Karyopharm [Brain tumor]; Merck [Brain tumor]; Mundipharma [Brain tumor]; Novartis [Brain tumor]; Novocure [Brain tumor]; Nuvation Bio [Brain tumor]; Prelude Therapeutics [Brain tumor]; Sagimet [Brain tumor]; Sapience [Brain tumor]; Servier [Brain tumor]; Vascular Biogenics [Brain tumor]; VBI Vaccines [Brain tumor]; Voyager [Brain tumor]. Other Financial Interest: Elsevier [Editor]. All of the relevant financial relationships listed have been mitigated. Lawrence LK Leung, MD No relevant financial relationship(s) with ineligible companies to disclose. April F Eichler, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/treatment-and-prevention-of-venous-thromboembolism-in-patients-with-brain-tumors/print 23/23