Clinical question: Do antiplatelet medications increase the risk of intracranial hemorrhage (ICH) in patients with metastatic brain tumors?
Background: Brain metastases increase the risk of intracranial hemorrhage in patients with advanced malignancies. The safety of the use of antiplatelet therapies in patients with brain metastases and cardiovascular disease is unknown.
Study design: Single-center, retrospective, matched-cohort study
Setting: 673-bed academic medical center at Beth Israel Deaconess Medical Center, Boston
Synopsis: To address the safety of antiplatelet therapies (aspirin and P2Y12 inhibitors) in patients with metastatic brain diseases and comorbid cardiovascular diseases, investigators conducted a single-center, retrospective, matched-cohort study of 392 patients with brain metastases. The primary endpoint of the study was the cumulative incidence of ICH after tumor diagnosis. The most common primary malignancies represented were lung cancer (non-small cell lung cancer, 74.0%). Of the 134 patients who were exposed to antiplatelet therapies, 116 patients (86.6%) were on aspirin alone. There was no statistically significant difference in the cumulative incidence of ICH at one year in patients on antiplatelet therapy compared to those patients who were not on antiplatelet agents (22.5% and 19.3%; P=0.22). The severity of the ICH was also statistically similar (P=.49). The subgroup who was on both antiplatelet agents along with anticoagulation (23.1%) did not experience a higher risk of major ICH compared with the use of antiplatelet agents alone. There was a slight survival advantage in the cohort of patients receiving antiplatelet agents.
Bottom line: The administration of antiplatelet therapies was not associated with an increase in the incidence, size, or severity of ICH in the setting of brain metastases
Citation: Miller EJ, et al. Antiplatelet medications and risk of intracranial hemorrhage in patients with metastatic brain tumors. Blood Adv. 2022;6(5):1559-1565. doi:10.1182/bloodadvances.2021006470.
Dr. Vaidyan is an associate professor of medicine and division director of general internal medicine at Saint Louis University School of Medicine, St. Louis, Mo.