cancer-associated thrombosis in brain tumors: challenges in diagnosis and management

Cancer-associated thrombosis (cat) represents a significant challenge in patients with brain tumors, with venous thromboembolism (vte) affecting up to 30% of those with high-grade gliomas and 20% of those with brain metastases or primary cns lymphoma. the primary clinical dilemma lies in balancing the prevention of thrombosis with the heightened risk of intracranial hemorrhage (ich). the heightened risk of vte is driven by tumor-induced hypercoagulability and the effects of cancer treatments. the present literature review evaluated evidence from pubmed/medline and web of science. clinical studies, mechanistic research, and guidelines (asco/nccn) were prioritized, while case reports and non-english studies were excluded. diagnosing vte in brain tumor patients is complicated by overlapping symptoms with tumor progression and treatment side effects, as well as limitations in imaging and biomarker tests. effective management of cat requires balancing the prevention of thrombosis with the minimization of ich risks. low-molecular-weight heparin (lmwh) remains the preferred anticoagulant, although direct oral anticoagulants (doacs) are emerging as potential alternatives. while prophylactic anticoagulation is recommended in high-risk perioperative settings, its routine use in other contexts remains controversial due to bleeding risks. the vte significantly impacts survival and quality of life, increasing mortality and symptom burden. future efforts should focus on improving risk stratification, exploring novel anticoagulants, and personalizing treatment plans. additionally, the limitations of existing studies, such as the lack of robust data on doacs in this population, must be addressed. multidisciplinary collaboration and ongoing research are crucial for advancing the prevention and treatment of cat in patients with brain tumors.