Approaches for the prevention and treatment of venous thromboembolism in a patient with anaplastic astrocytoma: a case report

Abstract

Venous thromboembolism occurs in 48–200 out of 1,000 patients with brain cancer per year, which is significantly more frequent than in general population.Case report. A female patient had surgical treatment of anaplastic astrocytoma following radiotherapy and chemotherapy (temozolomide, irinotecan, bevacizumab) at the age of 17 years old. She also received dexamethasone. At the age of 20 years, she developed cancer recurrence, that required chemotherapy. After chemotherapy had been initiated, the patient developed deep vein thrombosis of the legs. Rivaroxaban 20 mg/d for 2.5 months with the subsequent switch to enoxaparin 60 mg/d showed no recanalization. Enoxaparin dose increasing up to 160 mg/d demonstrated incomplete recanalization, however, superficial venous thrombosis of the legs developed. Combination therapy with enoxaparin plus warfarin resulted in further deep and superficial veins recanalization.Discussion. In cancer-associated venous thromboembolism that is resistant to low molecular weight heparin monotherapy, short-term combination therapy with low molecular weight heparin and vitamin K antagonists can be considered. However, in recurrent cancer standard treatment protocols can be ineffective.

Keywords

• anaplastic astrocytoma
• rivaroxaban
• enoxaparin
• anticoagulants
• low molecular weight heparin
• warfarin
• chemoradiation therapy
• deep vein thrombosis