Thromboprophylaxis in primary brain cancer

Venous thromboembolism represents a major source of morbidity and mortality in patients with cancer. Patients with intracranial malignancies, notably high-grade glioma, experience a particularly elevated thrombotic risk. At the same time, these patients are uniquely vulnerable to intracranial hemorrhage, which may occur spontaneously during the disease course even without exposure to anticoagulant therapy. This competing risk profile presents a substantial clinical challenge, as measures designed to avert life-threatening thromboembolic incidents may concurrently elevate the risk of catastrophic intracranial hemorrhage. Consequently, the role of thromboprophylaxis in patients with intracranial tumors remains uncertain. In this review, we critically assess the available evidence on thromboprophylaxis in this population, addressing its risks and potential benefits across diverse clinical settings.