# Evidence gap in predicting intracranial haemorrhage risk in people with glioma on anticoagulants: a scoping review

## TL;DR

This study finds no existing tools to predict brain bleeding risks in brain tumor patients on blood thinners, highlighting a need for new models.

## Contribution

The novel contribution is identifying a critical evidence gap in predictive modeling for intracranial haemorrhage risk in glioma patients on anticoagulants.

## Key findings

- No predictive models for intracranial haemorrhage risk in glioma patients on anticoagulants were found.
- Existing studies report on ICH risk but lack tailored predictive models for this specific clinical context.

## Abstract

People with glioma (PwG), a type of brain tumour, have an elevated risk of developing venous thromboembolism (VTE). When VTE occurs, anticoagulant therapy is typically initiated, and in some cases, it may be prescribed prophylactically. However, these patients are also at risk of intracranial haemorrhage (ICH) as a complication of anticoagulation. Despite the clinical importance of this risk-benefit balance, it remains unclear whether predictive tools exist to guide anticoagulation decisions in this population.

We conducted a scoping review to determine whether predictive models exist for estimating the risk of intracranial haemorrhage (ICH) in people with glioma (PwG) receiving anticoagulant therapy. For any models identified, we assessed their methodological quality and predictive performance. Our search included MEDLINE, EMBASE (via Ovid), and the Cochrane Library, covering publications up to 29 November 2024. Studies were eligible if they employed predictive modelling to assess ICH risk in anticoagulated PwG. Two reviewers independently screened studies and extracted data. We used the PROBAST tool to evaluate model quality.

Of the 1,585 articles screened, none met the inclusion criteria. Although some studies reported on ICH risk in PwG, none developed or validated predictive models tailored to this clinical context. One excluded study provides conceptual insights that may inform future modelling efforts.

The absence of these models underscores a critical gap in neuro-oncology research and highlights the urgent need for targeted model development to support anticoagulation decision-making in PwG.

The online version contains supplementary material available at 10.1186/s12883-025-04461-5.