From the Guidelines
Clexane (enoxaparin) is not contraindicated in patients with meningioma, but its use should be individualized based on the patient's specific clinical situation, weighing thrombotic risk against bleeding risk. Enoxaparin is a low molecular weight heparin commonly used for prevention and treatment of thromboembolic disorders. For patients with meningioma, the use of anticoagulants like Clexane may actually be beneficial in certain situations, as these patients have an increased risk of venous thromboembolism due to their underlying condition and potential immobility 1. The standard prophylactic dose is typically 40mg subcutaneously once daily, while treatment doses are weight-based (approximately 1mg/kg twice daily).
However, caution should be exercised if the patient is scheduled for neurosurgical intervention to remove the meningioma, as enoxaparin should be discontinued at least 24 hours before surgery to reduce bleeding risk. Additionally, if the meningioma has caused or is at high risk of causing intracranial bleeding, the risk-benefit ratio should be carefully evaluated before initiating anticoagulation, as anticoagulant therapy is absolutely contraindicated in patients with active intracranial bleeding 1.
Some key points to consider when deciding to use Clexane in a patient with meningioma include:
- The presence of a brain tumor per se is not a contraindication for anticoagulation for established VTE 1
- The use of LMWH, such as enoxaparin, is preferred for the treatment of established VTE in cancer patients with a brain tumor 1
- The decision to use anticoagulation should be individualized, taking into account the patient's specific clinical situation and weighing thrombotic risk against bleeding risk 1
From the Research
Clexane Contraindication in Meningioma
- There is no direct evidence in the provided studies that Clexane (enoxaparin) is contraindicated in meningioma patients 2, 3, 4, 5, 6.
- However, the studies suggest that low-molecular-weight heparin (LMWH), such as enoxaparin, can be used as a prophylactic measure to reduce the risk of venous thromboembolic events (VTE) in patients undergoing meningioma surgery 2, 4, 6.
- One study found that the use of enoxaparin did not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas 6.
- Another study suggested that the use of LMWH, such as enoxaparin, can reduce the risk of VTE in patients with meningiomas, especially those with skull base meningiomas 2.
- The studies also highlight the importance of individualized risk assessment and management of VTE in patients with meningiomas, taking into account factors such as tumor location, size, and patient mobility 3, 4, 5.
Venous Thromboembolic Events in Meningioma Patients
- Meningioma patients are at high risk for VTE, with a cumulative incidence of 8.7% reported in one study 3.
- The risk factors for VTE in meningioma patients include history of VTE, obesity, and lack of pharmacologic prophylaxis 3.
- The management of postoperative VTE in meningioma patients is highly variable, but most patients are ultimately treated with therapeutic anticoagulants 3, 5.