Anticoagulation Following Surgery for Glioblastoma: Case Report and Review of the Literature.

Patients with glioblastoma (GBM) have a high risk of venous thromboembolism (VTE), particularly after surgery, but a competing high risk of intracranial hemorrhage complicates the need for anticoagulation. We present a case of a 70-year-old male on dabigatran with a history of VTE who underwent GBM resection. A preoperative inferior vena cava (IVC) filter was placed to allow for temporary postoperative holding of chemical anticoagulation. Despite this, he developed progressive, life-threatening thromboembolism, including bilateral deep vein thromboses, a pulmonary embolism, and ultimately extensive thrombosis of the IVC extending into the right atrium, causing obstructive shock. This progression occurred despite the resumption of anticoagulation and necessitated a high-risk mechanical thrombectomy, which was complicated by cardiac arrest secondary to right atrial perforation. The patient ultimately survived. Given the questions raised by this case, we review the literature on the use of anticoagulation following surgery for GBM. We highlight the distinct risk profiles associated with prophylactic and therapeutic anticoagulation and suggest early thromboprophylaxis when not contraindicated.