{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:50:26Z","timestamp":1789105826766,"version":"build-2803163510"},"reference-count":26,"publisher":"American Society of Hematology","issue":"24","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Direct oral anticoagulants (DOACs) are increasingly prescribed in treatment of cancer-associated thrombosis, but limited data exist regarding safety of DOACs in patients with brain metastases. We aimed to determine the incidence of intracranial hemorrhage (ICH) in patients with brain metastases receiving DOACs or low-molecular-weight heparin (LMWH) for venous thromboembolism or atrial fibrillation. An international 2-center retrospective cohort study was designed. Follow-up started on the first day of concomitant anticoagulation and brain tumor diagnosis. At least 2 brain imaging studies were mandated. The primary outcome was the cumulative incidence of any spontaneous ICH at 12-month follow-up with death as a competing risk. Major ICH was defined as spontaneous, \u226510 mL in volume, symptomatic, or requiring surgical intervention. Imaging studies were centrally reviewed by a neuroradiologist blinded for anticoagulant type. PANWARDS (platelets, albumin, no congestive heart failure, warfarin, age, race, diastolic blood pressure, stroke) score for prediction of ICH was calculated. We included 96 patients with brain metastases (41 DOAC, 55 LMWH). The 12-month cumulative incidence of major ICH was 5.1% in DOAC-treated patients and 11.1% in those treated with LMWH (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.09-2.21). When anticoagulation was analyzed as a time-varying covariate, the risk of any ICH did not differ between DOAC- and LMWH-treated patients (HR, 0.98; 95% CI, 0.28-3.40). PANWARDS score was not associated with ICH risk. This international 2-center study suggests comparable safety of LMWH and DOACs in patients with brain metastases.<\/jats:p>","DOI":"10.1182\/bloodadvances.2020003238","type":"journal-article","created":{"date-parts":[[2020,12,19]],"date-time":"2020-12-19T05:45:23Z","timestamp":1608356723000},"page":"6291-6297","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":49,"title":["Intracranial hemorrhage with direct oral anticoagulants in patients with brain metastases"],"prefix":"10.1182","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2245-345X","authenticated-orcid":false,"given":"Avi","family":"Leader","sequence":"first","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;"},{"name":"Hematology Institute, Rabin Medical Center, Petah Tikva, Israel;"},{"name":"Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9340-8771","authenticated-orcid":false,"given":"Eva N.","family":"Hamuly\u00e1k","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Carney","sequence":"additional","affiliation":[{"name":"Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Avrahami","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelijn J.","family":"Knip","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Rozenblatt","sequence":"additional","affiliation":[{"name":"Department of Radiology, Rabin Medical Center, Petah Tikva, Israel;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9204-1026","authenticated-orcid":false,"given":"Ludo F. M.","family":"Beenen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shlomit","family":"Yust-Katz","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;"},{"name":"Neurooncology Unit and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9857-877X","authenticated-orcid":false,"given":"Oded","family":"Icht","sequence":"additional","affiliation":[{"name":"Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6891-9062","authenticated-orcid":false,"given":"Michiel","family":"Coppens","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Raanani","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;"},{"name":"Hematology Institute, Rabin Medical Center, Petah Tikva, Israel;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1006-6420","authenticated-orcid":false,"given":"Saskia","family":"Middeldorp","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry R.","family":"B\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The 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