D-Dimer Elevation and Paresis Predict Thromboembolic Events During Bevacizumab Therapy for Recurrent Malignant Glioma

作者：Misch Martin; Czabanka Marcus; Dengler Julius; Stoffels Mandy; Auf Gregor; Vajkoczy Peter; Stockhammer Florian^*

来源：Anticancer Research, 2013, 33(5): 2093-2098.

• Recurrent malignant glioma
• bevacizumab
• deep venous thrombosis
• D-dimer

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 anticoagulants. 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, chi(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.

• 出版日期2013-5