- The only evidence available on the risk of cerebral haemorrhage in patients with brain metastases anticoagulated for for deep vein thrombosis (DVT) or pulmonary embolism (PE) comes from a single retrospective comparative study (level III.2 evidence). In this observational study of 42 patients, three patients experienced severe cerebral haemorrhages while being anticoagulated, an incidence rate of 7.1% (95% CI:1.5 to 19.5). Since the decision to treat patients with anticoagulants or inferior vena cava filters was made on the basis of perceived contraindications to anticoagulants and various combinations and dosages of anticoagulation were administered, the findings from this study would not be considered reliable or generalisable.
- Two other studies (also retrospective comparative studies) that were identified included patients with either primary or metastic brain cancer, but there was insufficient data reported to make it possible to determine the risk of cerebral haemorrhage with anticoagulation in the group with metastatic brain cancer. Even if this information had been available, similar reservations on the reliability and generalisability of this evidence would apply.