Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms

Bang, Oh Young; Chung, Jong‐Won; Lee, Mi Ji; Seo, Woo‐Keun; Kim, Gyeong‐Moon; Ahn, Myung‐Ju; Investigators, OASIS-Cancer Study

doi:10.5853/jos.2019.02278

Cited by 126 publications

(127 citation statements)

References 86 publications

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“…[13] Therefore, the D-dimer level is typically increased in those with cardioembolic strokes [14] and is useful for detecting cancer-associated strokes. [15] In accord with previous studies, our results also showed that D-dimer level was associated with the stroke mechanism, with cardioembolic stroke being an independent factor associated with elevated D-dimer levels. As D-dimer is elevated in acute ischemic stroke patients and as thrombolysis and the stroke mechanism in uences the D-dimer level, it may be less useful for detecting DVT in patients with acute ischemic stroke.…”

Section: Discussionsupporting

confidence: 92%

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

Kim

Heo

et al. 2020

Preprint

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Background: Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke.Methods: Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (>0.5 mg/dl) in acute ischemic stroke patients.Results: During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR=2.579, 95% CI=1.224–5.432; p=0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR=1.191 95% CI=1.095–1.294; p=0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolic stroke (OR=3.777, 95% CI=1.532–9.313; p=0.004; reference: large artery atherosclerosis), NIHSS score (OR=1.087, 95% CI=1.002–1.179; p=0.001) and thrombolysis (OR=12.360, 95% CI 2.456-62.213; p=0.002) were independently associated with elevated abnormal D-dimer levels.Conclusion: The severity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.

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Section: Discussionsupporting

confidence: 92%

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

Kim

Heo

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…[13] Therefore, the D-dimer level is typically increased in those with cardioembolic strokes [14] and is useful for detecting cancer-associated strokes. [15] In accord with previous studies, our results also showed that D-dimer level was associated with the stroke mechanism, with cardioembolic stroke being an independent factor associated with elevated D-dimer levels. As D-dimer is elevated in acute ischemic stroke patients and the stroke mechanism influences the D-dimer level, it may be less useful for detecting DVT in patients with acute ischemic stroke.…”

Section: Discussionsupporting

confidence: 92%

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

Kim

Heo

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke. Methods: Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (>0.5 mg/dl was regarded as abnormal) in acute ischemic stroke patients. Results: During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR=2.579, 95% CI=1.224–5.432; p=0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR=1.191 95% CI=1.095–1.294; p=0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolism (OR=3.440 95% CI=1.051–4.078; p=0.006; reference: large artery atherosclerosis), and high NIHSS score (OR=1.135, 95% CI 1.051–1.224; p=0.001) were independently associated with elevated abnormal D-dimer level. Conclusion: The s everity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. Performing LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.

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“…2 NBTE is a cause of stroke and most frequently develops in patients with systemic cancer. 3,4 Most information on NBTE in stroke is derived from case reports or post-mortem studies because of its rarity. [5][6][7][8] Although patients with acute stroke and active cancer are known to have a substantial short-term risk of recurrent stroke, 9 the outcomes of stroke patients with cancer-associated NBTE are not well known.…”

Section: Introductionmentioning

confidence: 99%

“…Nonbacterial thrombotic endocarditis (NBTE) is characterized by noninfectious vegetation on the cardiac valves [ 2 ]. NBTE is a cause of stroke and most frequently develops in patients with systemic cancer [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis

et al. 2020

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Background and Purpose Nonbacterial thrombotic endocarditis (NBTE) is a cause of stroke in cancer. However, clinical characteristics and outcomes in stroke patients with cancer-associated NBTE are not well known.<br/>Methods We included consecutive patients with stroke and active cancer over a 9-year period who underwent echocardiography. We retrospectively compared clinical characteristics and presence of metastasis between patients with NBTE, those with cryptogenic etiologies, and those with determined etiologies. We also investigated mortality and stroke events during the 6-month follow-up.<br/>Results Among the 245 patients, 20 had NBTE, 96 had cryptogenic etiologies, and 129 had determined etiologies. Metastasis was seen in all 20 patients (100%) with NBTE, 69.8% in patients with cryptogenic etiology, and 48.8% in patients with or determined etiology. During the 6-month follow-up, 127 patients (51.8%) developed stroke and/or died (death in 110 [44.9%] and stroke events in 55 [22.4%]). Patients with NBTE showed significantly higher mortality (80%) and stroke occurrence (50%) than those with cryptogenic etiologies (mortality 54.2%, stroke 25.0%, log-rank P=0.006) and determined etiologies (mortality 32.6%, stroke 16.3%, log-rank P<0.001). In a multivariate Cox proportional hazard analysis, the presence of NBTE was independently associated with composite outcomes of mortality and stroke events (hazard ratio, 1.941; 95% confidence interval, 1.052 to 3.690).<br/>Conclusions NBTE should be suspected as a potential cause of stroke in patients with metastatic cancer. Patients with NBTE have a high risk of recurrent stroke and mortality. Future studies are necessary to determine strategies to reduce stroke recurrence in patients with NBTE.

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Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms

Cited by 126 publications

References 86 publications

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis

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