Intracranial Hemorrhage With Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin in Brain Tumors
Thiago Oscar Goulart, Chen Wang, Kenshiro Fuse, Maria Daniela Zambrano Espinoza, Yasir Bukhari, John Y. Rhee
Abstract
BACKGROUND AND OBJECTIVES: Patients with brain tumors face an increased risk of arterial and venous thromboembolic events. However, owing to risk of intracranial hemorrhage (ICH), clinician practice patterns vary on preference for anticoagulation treatment. This meta-analysis evaluates the safety of direct oral anticoagulants (DOACs) vs low-molecular-weight heparin (LMWH) on the development of ICH in patients with brain tumor. METHODS: ) and bias were evaluated, with prespecified subgroups (tumor type, follow-up duration, and study quality) and sensitivity analyses. The study protocol was registered on PROSPERO (CRD42025635334). RESULTS: = 0.59) tests showed no statistical evidence of publication bias. DISCUSSION: In the current meta-analysis, DOACs were associated with significantly lower ICH risk than LMWH in patients with anticoagulated brain tumor, particularly those with primary brain tumors. Findings support DOACs as a safe anticoagulant in arterial and venous thromboembolism. Given observational designs with inherent confounding, findings warrant cautious interpretation.