Platelet inhibition delays time to neurosurgical intervention for cerebral metastasis in non-small cell lung cancer

An inverse association between the use of platelet inhibitors and the risk of cancer has been reported by numerous epidemiological studies in the past. The effects of antiplatelet agents on the cerebral metastasis formation of non-small cell lung cancer (NSCLC) are largely unknown. We therefore, investigated the effect of platelet inhibition in NSCLC patients at the time of the first diagnosis of cerebral metastases. We retrospectively investigated the clinical course of 417 NSCLC patients with cerebral metastases who underwent craniotomy for metastasis resection during the course of their disease. The presence of platelet inhibition prior to cerebral metastases diagnosis was used to dichotomize the cohort. Relevant clinical parameters, time to neurosurgical intervention for cerebral metastases, overall survival, and the incidence of intracranial hemorrhage or hemorrhagic transformation of metastases, were compared between the two groups. The presence of platelet inhibitor intake was associated with a significantly prolonged time to neurosurgical intervention for cerebral metastases in non-small cell lung cancer 63 vs. 47 months; (p = 0.001). Furthermore, platelet inhibitor intake was also associated with an increased overall survival of 12 vs. 10 months (p = 0.02). Statistically, no increased risk of hemorrhagic transformation of the metastasis or intracranial hemorrhage was found (p = 0.635 and p = 1.000), respectively. In this retrospective study, the use of platelet inhibitors was not associated with an increased risk of intracranial hemorrhage, the use of platelet inhibitors was associated with delayed need for neurosurgical treatment for cerebral metastases and improved overall survival in NSCLC patients.