Multinational cohort study of intracranial hemorrhage in patients with brain metastases receiving anticoagulation
Bibliographic record
Abstract
Multinational cohort study of intracranial hemorrhage in patients with brain metastases receiving anticoagulationSpontaneous intracranial hemorrhage (ICH) represents a common complication in patients with brain metastases.1,2 As cardiovascular complications, including venous thromboembolism (VTE), are prevalent in cancer patients, many patients with brain metastases have an indication for therapeutic anticoagulation.The incidence rate of ICH with anticoagulation is approximately 15% in patients with metastatic brain cancer.2 Although anticoagulation increases the risk of any bleeding event, prior cohort studies suggest that the risk of ICH in patients with brain metastases is similar with or without anticoagulation.1,2,3 While two small retrospective cohort studies suggest safety of direct oral anticoagulants (DOAC) compared to low-molecular-weight heparin (LMWH) in this population, 4,5 due to the limited sample sizes and wide Confidence Intervals (CI) of point estimates, the ICH profile of DOAC versus LWMH in patients with metastatic brain tumors remains uncertain.Data are also lacking regarding risk factors for ICH and clinical and radiological presentation of ICH, as well as outcomes following ICH including recurrent thrombosis and recurrent hemorrhage after re-initiation of anticoagulation.To address these knowledge gaps, we conducted a multinational cohort study to compare rates of hemorrhage among patients with brain metastases treated with DOAC or LMWH and evaluate outcomes including mortality, recurrent thrombosis, and hemorrhage.The Anticoagulation in Brain Cancer (ABC) Study was a retrospective cohort study involving 12 academic and non-academic hospitals in Canada, Israel, Mexico, Switzerland, the Netherlands, and the United States.The study protocol was approved by local medical ethics committees.Informed consent was waived and the study was conducted in line with local regulations.We screened the records of all patients in the hemato-oncology or medical oncology departments at the study centers between January 1 st , 2014 and January 1 st , 2022 for eligibility.The study included adult patients with systemic solid cancer and brain metastases confirmed through pathology and imaging, respectively.Eligibility criteria were active cancer, defined as newly diagnosed or undergoing treatment, and therapeutic anticoagulation (both full dose and indicated dose reductions prescribed with therapeutic intent) with either DOAC or LMWH.Patients with ICH before the initiation of anticoagulation and those lacking any follow-up data were excluded.Repeat brain imaging during follow-up was not a prerequisite for inclusion.Study index was defined as the first day of concurrent anticoagulation and brain metastases diagnosis, and patients were followed for 12 months.An additional 90-day follow-up was conducted for patients who experienced anticoagulation-related ICH to
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".