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Algorithm of Gerber et al for Managing a Patient with Venous Thromboembolism and a Primary or Metastatic Brain Tumor

Description

Gerber et al developed an algorithm for managing venous thromboembolism in a patient with a primary or metastatic brain tumor. This can help balance risks and benefits of the possible interventions in these patients. The authors are from Johns Hopkins University in Baltimore.


 

Patient selection:

(1) primary or metastatic brain tumor

(2) presence of venous thromboembolism

 

Indications for placement of a filter in the inferior vena cava (IVC):

(1) craniotomy within the past 3 to 5 days

(2) brain metastates due to malignant melanoma, renal cell carcinoma, choriocarcinoma, or thyroid cancer (relative contraindications to anticoagulation therapy)

(3) contraindications to anticoagulation

(4) evidence of recent bleeding on a noncontrast head CT

 

If an IVC filter is not placed for these reasons, then the patient is evaluated for (1) signs and symptoms of acute or progressive venous thromboembolism and (2) ability to tolerate anticoagulation for 24 hours or longer.

Signs Progressive VTE

Tolerate Anticoagulation

Therapy

severe

yes

IV heparin with full bolus; start long term anticoagulation

severe

no

IV heparin with full bolus; place IVC filter

moderate

yes

IV heparin with mini bolus; start long term anticoagulation

moderate

no

IV heparin with mini bolus; place IVC filter

no

yes

IV heparin without bolus; start long term anticoagulation

no

no

IV heparin without bolus; place IVC filter

 


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Specialty

ICD-10