Coagulopathy and embolic signal in cancer patients with ischemic stroke

Seok, Jin Myoung; Kim, Seon Gyeong; Kim, Ji Won; Chung, Chin‐Sang; Kim, Gyeong‐Moon; Lee, Kwang Ho; Bang, Oh Young

doi:10.1002/ana.22050

Cited by 144 publications

(148 citation statements)

References 29 publications

(40 reference statements)

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“…15,16 Because of the advances in cancer medicine and the steadily increasing proportion of elderly people, the number of people living with cancer is increasing. As a consequence, the proportion of patients who have cancer is expected to increase among patients with stroke, especially in those without other stroke pathogeneses.…”

Section: Evaluation Of Cryptogenic Stroke With Advanced Diagnostic Tementioning

confidence: 99%

“…The detection of an embolic signal with TCD may provide clues on the cancer-specific mechanism related to hypercoagulopathy and may be used to monitor the effect of treatment in the acute stroke period. 16 Unlike nonbacterial thrombotic endocarditis, 61 these patients usually had multiple small diffusion-weighted imaging (DWI) lesions with microembolic signals on TCD monitoring, and TEE usually did not reveal vegetations, suggesting intravascular coagulopathy. …”

Section: Workup For Cancer-related Coagulopathymentioning

confidence: 99%

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Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang

Ovbiagele

Kim

2014

Stroke

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Section: Evaluation Of Cryptogenic Stroke With Advanced Diagnostic Tementioning

confidence: 99%

Section: Workup For Cancer-related Coagulopathymentioning

confidence: 99%

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang

Ovbiagele

Kim

2014

Stroke

Self Cite

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“…5,11,12 A recent Korean multicenter study showed that 60% of stroke events among cancer patients are associated with conventional mechanisms, such as atherosclerotic and cardioembolic causes. The remaining 40% are of the cryptogenic mechanism, likely including cancer-related causes.…”

Section: Discussionmentioning

confidence: 99%

Lung Cancer and Incidence of Stroke

Chen

Muo

Lee

et al. 2011

Stroke

106

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Background and Purpose-Stroke is a known cerebrovascular complication in lung cancer patients; however, whether lung cancer patients are at elevated risk of developing stroke relative to the noncancer population remains unclear. Methods-The present study used population-based claims data from the Taiwan National Health Insurance, which identified 52 089 patients with an initial diagnosis of lung cancer between 1999 and 2007, and 104 178 matched noncancer subjects from all insured subjects age 20 years and older. Subsequent occurrence of stroke was measured until 2008, and the association between lung cancer and the hazard of developing stroke was estimated using Cox proportional hazard models. Results-The incidence of stroke was 1.5 times higher (25.9 versus 17.4 per 1000 person-years) in the lung cancer group compared with the comparison group. The multivariate-adjusted hazard ratio (HR) comparing lung cancer patients with the noncancer group was 1.47 (95% CI, 1.39 -1.56) for stroke, 1.78 (95% CI, 1.54 -2.05) for hemorrhagic stroke, and 1.43 (95% CI, 1.34 -1.51) for ischemic stroke. The risk of stroke fell over time, decreasing after 1 year of follow-up for men and after 2 years of follow-up for women. Within the first year of follow-up, the risk of stroke peaked during the first 3 months for men and within 4 to 6 months for women. Conclusions-Lung cancer is associated with increased risk of subsequent stroke within 1 year after diagnosis for men and 2 years after diagnosis for women. (Stroke. 2011;42:3034-3039.)

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“…Suggesting microembolic mechanisms in those patients, the incidence of high-intensity transient signals correlated significantly with d-dimer levels in patients not displaying conventional stroke mechanisms. 14 These results have recently been reviewed by Bang et al in 2011 15 ; however, neither study included a control group and both studies are still expecting replication outside South Korea.…”

Section: Strokementioning

confidence: 92%

Stroke and Cancer

Schwarzbach

Schaefer

Ebert

et al. 2012

Stroke

226

117

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Background and Purpose-The importance of cancer-associated hypercoagulability as a possible stroke etiology in patients with cancer has received relatively little attention to date. A recent study has suggested that cancer-associated hypercoagulation may be of special importance in the absence of conventional stroke mechanisms. Methods-We identified patients with ischemic stroke sequentially admitted to our stroke center with the additional diagnosis of active and malignant cancer from 2002 to 2011. By using our prospectively collected stroke, MRI, and laboratory data banks, the etiology and risk factors of stroke, types of cancer, deep vein thrombosis/pulmonary embolism, d-dimer levels, and diffusion-weighted imaging lesion patterns were compared to an age-and sex-matched control group. Patients with cancer with a conventional stroke etiology and patients with an unidentified and/or cancer-associated stroke etiology were analyzed separately. Results-One hundred forty patients with cancer and 140 control subjects were included. Unidentified stroke (P<0.001) and infarction in multiple vascular territories (P<0.001) were significantly more frequent and d-dimer levels significantly higher (P<0.05) in patients with cancer. Vice versa, risk factors such as hypertension (P<0.05) and hyperlipidemia (P<0.01) were more prevalent in control subjects. Deep vein thrombosis and pulmonary embolism were more frequent (P<0.01) and d-dimer levels higher (P<0.01) in the patients with unidentified and/or cancerassociated stroke etiology compared to the patients with cancer with a conventional stroke etiology. Lung and pancreatic cancer were significantly overrepresented and d-dimer levels higher in these patients compared with other patients with cancer (P<0.01). Conclusions-Our data confirm the concept of cancer-associated hypercoagulation as a widely underestimated important stroke risk factor in patients with cancer, especially in those with severely elevated

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Coagulopathy and embolic signal in cancer patients with ischemic stroke

Abstract: A high prevalence of ES was observed in cancer patients with ischemic stroke, especially in those without CSMs. Elevated D-dimer levels were independently associated with ES, and decreased dramatically with the use of anticoagulants. ANN NEUROL 2010;68:213-219.

Cited by 144 publications

References 29 publications

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Lung Cancer and Incidence of Stroke

Stroke and Cancer

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