Treatment of Deep Vein Thrombosis and Pulmonary Emboli in Patients With Primary and Metastatic Brain Tumors

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Abstract
To the Editor. —It was with great interest that I read the recent article by Olin et al,1 with regard to therapeutic options in patients with primary and metastatic brain tumors who suffer from deep venous thrombosis and pulmonary emboli (PE). A retrospective study by Choucair et al2 supports the contention that anticoagulation in patients with primary brain tumors is reasonably safe, with 22 glioma patients with computed tomographic (CT) evidence of enhancing tumor undergoing systemic anticoagulation without intracranial hemorrhage. Olin et al1 present an additional 16 patients with primary brain tumors anticoagulated without clinically significant intracranial hemorrhage. Unfortunately, the data for patients with metastatic disease remain essentially anecdotal with only nine patients with cerebral metastasis receiving anticoagulants in their study. Reviewing all the patients with cerebral metastasis at our institution from 1982 through 1986 (69 total patients) revealed two patients anticoagulated in the face of untreated