How do you manage anticoagulation for patients with DVT/PE who have brain metastases?

Not all brain metastases pose the same risk to patients. Rapid, numerous (even if tiny), new onset metastases from RCC or melanoma (especially BRAF mutant) can go from asymptomatic to life threatening hemorrhage within 1-2 weeks and I would strongly caution anti-coagulation in these patients. If the...

As a general rule, there is no need to hold anticoagulation in patients with brain metastases. A number of retrospective studies and at least one meta-analysis demonstrated that there is no increased risk of intracranial hemorrhage with anticoagulation. The most recent study was a matched cohort stu...

Asked to update the answer below that I provided in 2017 in regard to the role of DOACs.

Simple answer, the general concept/issues still stand, and

1. I consider DOACs as an alternative to LMWH, and it is more frequently used now over LMWH
2. ASCO has updated their VTE guidelines including data with DOACs...

I agree - classically hemorrhagic brain mets include melanoma, RCC, choriocarcinoma, and thyroid cancer, and these I feel are higher risk. Others have commented with references in detail, but I believe unfortunately this does have to be individualized (factoring in issues such as coagulopathy and hy...