Cancer Occurrence After a Cerebral Venous Thrombosis: A Nationwide Registry Study

Sipilä, Jussi; Ruuskanen, Jori O.; Heervä, Eetu; Posti, Jussi P.; Rautava, Päivi; Kytö, Ville

doi:10.1161/strokeaha.122.038685

Cited by 5 publications

(6 citation statements)

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“…27 The reason behind the high risk of intracranial herniation in patients with malignant CVST is the high clot load generated as a result of the prothrombotic state triggered by many mechanisms, such as late initiation of anticoagulant therapy in patients and damage to the blood-brain barrier. 29,30 Our results are consistent with those reported in the literature, 7 wherein poor clinical outcomes and death were more frequent in CVST patients with intracranial herniation.…”

Section: Discussionsupporting

confidence: 92%

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

et al. 2023

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Background Cerebral venous sinus thrombosis (CVST) is not as well understood as an ischemic stroke of arterial origin. Although the prognosis of CVST is usually good, parenchymal lesions may occur in some patients, and the development of intracranial herniation may result in death. For this reason, recognizing the risk factors for intracranial herniation and accurately determining those patients who should undergo decompressive craniectomy is important. Objective This study aims to determine the risk factors for intracranial herniation in patients with CVST. Methods A total of 177 patients diagnosed with CVST between 2015 and 2021 in our tertiary center were retrospectively included in this study. Results Of the 177 patients, 124 were female and 53 were male with mean ages of 40.65 ± 13.23 and 44.13 ± 17.09, respectively. Among those, 18 patients had developed intracranial herniation. A significant statistical relationship was observed between superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, presence of malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis. The binary logistic regression analysis results showed that the most significant variables were the venous collateral score of 0, malignancy, and small juxtacortical hemorrhages. Conclusion This study identified small juxtacortical hemorrhages, the presence of malignancy, and a venous collateral score of 0 to be independent risk factors for intracranial herniation in CVST patients. Drawing on these results, we recommend close clinical observation of CVST patients, as they may be candidates for decompressive craniectomy.

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Section: Discussionsupporting

confidence: 92%

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

et al. 2023

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“…Although cancer is a well-established cause of other venous thromboses, such as DVT/PE, 5 few investigations have focused on CVT. 16,17 Using Finnish registries, Sipilä et al 17 reported that among 589 patients with CVT diagnosed between 2005 and 2007, 2.3% received a cancer diagnosis within 2 years following CVT diagnosis. The absolute risk found in our study (eg, 1.9% after 12 months) resembles that finding.…”

Section: Discussionmentioning

confidence: 99%

“…28 Although cancer is a well-established cause of other venous thromboses, such as DVT/PE, 5 few investigations have focused on CVT. 16,17 Using Finnish registries, Sipilä et al 17 adjusted odds ratio of cancer of 4.9 (95% CI, 3.5-6.8), suggesting that cancer is a potent risk factor for CVT. We also assessed the impact of a CVT diagnosis on cancer prognosis, extending previous research.…”

Section: Discussionmentioning

confidence: 99%

“…Although a few previous studies have reported a high prevalence of cancer (7%-9%) among patients with CVT, 1,14,15 few have investigated whether cancer is a risk factor for CVT. 16,17 We investigated the risk of a cancer diagnosis among patients with CVT compared with the expected cancer risk in the Danish general population. We also compared the survival of patients with both CVT and cancer with the survival of patients with cancer but without CVT.…”

mentioning

confidence: 99%

“…Although a few previous studies have reported a high prevalence of cancer (7%–9%) among patients with CVT, 1,14,15 few have investigated whether cancer is a risk factor for CVT. 16,17…”

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confidence: 99%

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Risk and Prognosis of Cancer in Patients With Cerebral Venous Thrombosis Compared With the Danish General Population

Skajaa,

Farkas,

Adelborg

et al. 2023

Stroke

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BACKGROUND: Whether cerebral venous thrombosis (CVT) is a marker of cancer in clinical practice remains unknown. Little is known about the prognosis of cancer detected subsequent to CVT. METHODS: We used Danish nationwide registries (1996–2019) to identify patients with a first-time primary inpatient diagnosis of CVT without a history of cancer (N=811, 65% women, median age 42 years). We assessed the risk of an incident cancer diagnosis using standardized incidence ratios (SIRs). This measure contrasts the number of observed cancers among patients with CVT to the number of expected cancers where patients with CVT have the same cancer risk as the general population. We used Kaplan-Meier survival analysis and Cox regression to compare the survival of patients with both cancer and CVT with the survival of patients with cancer but without CVT, matched on cancer site, sex, age, and year of cancer diagnosis. RESULTS: Observing 43 incident cancer cases during follow-up, the overall SIR was unity (SIR, 1.04 [95% CI, 0.75–1.40]). However, the risk was ≈7-fold the expected level in the first 3 months following CVT diagnosis (SIR, 7.00 [95% CI, 3.02–13.80]) and ≈2-fold the expected level from 3 to 12 months following CVT diagnosis (SIR, 2.21 [95% CI, 0.89–4.56]). By 12 months following CVT diagnosis, the risk resembled the expected level (SIR, 0.76 [95% CI, 0.50–1.09]). Survival among cancer patients with prior CVT versus cancer patients without prior CVT was 91% versus 87% after 6 months and 65% versus 70% after 5 years. The adjusted hazard ratio of death was 0.78 (95% CI, 0.44–1.38). CONCLUSIONS: Patients with CVT were not at overall increased risk of a cancer diagnosis, except in the first 3 months after diagnosis during which period the risk was elevated ≈7-fold. The estimate from this early period, however, was based on only a few cancer diagnoses. Unlike other forms of venous thrombosis, a prior diagnosis of CVT did not negatively impact cancer survival.

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Canadian Stroke Best Practice Recommendations, 7^th Edition: Cerebral Venous Thrombosis, 2024

Field,

Lindsay,

Wein

et al. 2024

Can. J. Neurol. Sci.

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The 7th edition of the Canadian Stroke Best Practice Recommendations (CSBPR) is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners, and intended to drive healthcare excellence, improved outcomes and more integrated health systems. This edition includes a new module on the management of cerebral venous thrombosis (CVT). Cerebral venous thrombosis is defined as thrombosis of the veins of the brain, including the dural venous sinuses and/or cortical or deep veins. Cerebral venous thrombosis is a rare but potentially life-threatening type of stroke, representing 0.5–1.0% of all stroke admissions. The reported rates of CVT are approximately 10–20 per million and appear to be increasing over time. The risk of CVT is higher in women and often associated with oral contraceptive use and with pregnancy and the puerperium. This guideline addresses care for adult individuals who present to the healthcare system with current or recent symptoms of CVT. The recommendations cover the continuum of care from diagnosis and initial clinical assessment of symptomatic CVT, to acute treatment of symptomatic CVT, post-acute management, person-centered care, special considerations in the long-term management of CVT, including pregnancy and considerations related to CVT in special circumstances such as trauma and vaccination. This module also includes supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.

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Cancer Occurrence After a Cerebral Venous Thrombosis: A Nationwide Registry Study

Abstract: Sources of FundingThis study was supported by the Government's Special Financial Transfer tied to academic research in Health Sciences (Finland).

Cited by 5 publications

References 5 publications

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

Risk and Prognosis of Cancer in Patients With Cerebral Venous Thrombosis Compared With the Danish General Population

Canadian Stroke Best Practice Recommendations, 7^th Edition: Cerebral Venous Thrombosis, 2024

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Cancer Occurrence After a Cerebral Venous Thrombosis: A Nationwide Registry Study

Abstract: Sources of FundingThis study was supported by the Government's Special Financial Transfer tied to academic research in Health Sciences (Finland).

Cited by 5 publications

References 5 publications

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis

Risk and Prognosis of Cancer in Patients With Cerebral Venous Thrombosis Compared With the Danish General Population

Canadian Stroke Best Practice Recommendations, 7th Edition: Cerebral Venous Thrombosis, 2024

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Canadian Stroke Best Practice Recommendations, 7^th Edition: Cerebral Venous Thrombosis, 2024