Antiplatelet agents do not increase the incidence, size, or severity of intracranial hemorrhage (ICH) in patients with brain metastases, according to a study published in Blood Advances.
The research also suggests that combining antiplatelet agents and anticoagulants does not increase the risk of major ICH.
This matched cohort study included 392 patients with metastatic brain tumors at primary tumor diagnosis. The patients had a median age of 66.1 years, and 53.1% were women. The most common primary malignancy was non-small cell lung cancer (NSCLC; 74.0%), followed by small-cell lung cancer (9.9%), melanoma (4.6%), and renal cell carcinoma (4.3%).
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Of the entire cohort, 134 patients were exposed to antiplatelet agents, and 258 were not. In the antiplatelet arm, 86.6% of patients received aspirin alone. Other treatments included clopidogrel alone (3.0%) or with aspirin (9.0%), ticagrelor plus aspirin (0.7%), and prasugrel plus aspirin and clopidogrel (0.7%).
Patients in both arms received therapeutic anticoagulation within 30 days before diagnosis or at any time after (22.4%). Of this group, 91% received enoxaparin, 9% received apixaban, and 5% received rivaroxaban. Four patients received multiple anticoagulants.
Overall Results
The cumulative incidence of any ICH at 1 year was 22.5% in the antiplatelet arm and 19.3% in the control arm (P =.22). The cumulative incidence of major ICH was 5.5% and 5.4%, respectively (P =.80). There was no significant difference in the volume of ICHs between the arms (P =.49).
In the antiplatelet arm, 23.1% of patients received anticoagulants and antiplatelet agents. Anticoagulation did not increase the risk of major hemorrhage in the antiplatelet arm when compared with no antiplatelet agents and no anticoagulation (hazard ratio [HR], 0.51; 95% CI, 0.11-2.25; P =.37).
Likewise, the combination of antiplatelet agents and anticoagulants did not increase the risk of major ICH when compared with antiplatelet agents alone (HR, 0.40; 95% CI, 0.05-3.25; P =.39) or no antiplatelet agents and no anticoagulation (HR, 0.47; 95% CI, 0.06-3.65; P =.47).
There was a significant difference in overall survival (OS) between patients exposed to antiplatelet agents and those in the control arm. The median OS was 9.4 months and 8.2 months, respectively (P =.03).
The diagnosis of major ICH was not linked to shorter OS (HR, 0.71, 95% CI 0.48-1.03).
Results in NSCLC
Among patients with NSCLC, the cumulative incidence of any ICH at 1 year was 17.0% in the antiplatelet arm and 18.6% in the control arm (P =.95).
The combined use of aspirin and anticoagulation did not increase the risk of ICH when compared with no antiplatelet agents and no anticoagulation (HR, 1.06; 95% CI, 0.41-2.74; P =.91) or with antiplatelet agents only (HR, 0.90; 95% CI, 0.34-2.42; P =.84).
The median OS was 9.3 months for NSCLC patients exposed to antiplatelet agents and 8.3 months for those who were not (P =.07).
“The findings of this study support the use of antiplatelet agents in patients with brain metastases when clinically indicated,” the researchers concluded. “The apparent safety with the combined use of antiplatelet and anticoagulant therapy is reassuring but warrants confirmatory investigation.”
Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Miller EJ, Patell R, Uhlmann EJ, et al. Anti-platelet medications and risk of intracranial hemorrhage in patients with metastatic brain tumors. Blood Adv. Published online January 27, 2022. doi:10.1182/bloodadvances.2021006470
