Plasma D‐dimer levels and ischaemic lesions in multiple vascular regions can predict occult cancer in patients with cryptogenic stroke

Gon, Yasufumi; Sakaguchi, Manabu; Takasugi, Junji; Kawano, Tetsuya; Kanki, Hideaki; Watanabe, Akihiro; Oyama, Naoki; Terasaki, Yasukazu; Sasaki, Tsutomu; Mochizuki, Hideki

doi:10.1111/ene.13234

Cited by 63 publications

(58 citation statements)

References 28 publications

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“…Certain biological markers such as increased C-reactive protein (CRP), an unspecific acute phase reactant, and elevated fibrinogen and D-dimer, signaling a hypercoagulable state, have been suggested to have predictive values for underlying cancer [12, 13]. Radiological findings such as multiple acute cerebral infarcts (MACI) and specific cancer-related stroke patterns on diffusion weighted imaging (DWI) have also been suggested [13-16]. …”

Section: Introductionmentioning

confidence: 99%

When to Screen Ischaemic Stroke Patients for Cancer

et al. 2018

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Background and Purpose: Ischemic stroke can be the first manifestation of cancer and it is therefore important to ascertain which stroke patients should be considered for cancer-diagnostic investigations. We aimed to determine the frequency of active cancer in patients with acute ischemic stroke and to compare clinical findings in stroke patients with active cancer to ischemic stroke patients with no history of cancer. Finally, we aimed to develop a predictive and feasible score for clinical use to uncover underlying malignancy. Methods: All ischemic stroke patients admitted to the stroke unit in the Department of Neurology, Haukeland University Hospital were consecutively included in the Norwegian Stroke Research Registry (NORSTROKE). Stroke etiology was determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Data on cancer diagnoses was obtained from patients’ medical records and the Cancer Registry of Norway. Active cancer was defined as cancer diagnosis, metastasis of known cancer, recurrent cancer or receiving cancer treatment, all within 12 months before or after the index stroke. Based on variables independently associated with active cancer, a predictive score was developed using the area under the receiver operating characteristic (AUC-ROC) curves. Bayes’ theorem was used to calculate post-test probabilities of active cancer. Results: Of the 1,646 ischemic stroke patients included, 82 (5.0%) had active cancer. Increased D-dimer (OR = 1.1, 95% CI: 1.1–1.2, p = <0.001), lower Hb (OR = 0.6, 95% CI: 0.5–0.7, p = <0.001), smoking (OR = 2.2, 95% CI: 1.2–4.3, p = 0.02) and suffering a stroke of undetermined etiology (OR = 1.9, 95% CI: 1.1–3.3, p = 0.03) were factors independently associated with active cancer. These were included in the final predictive score which gave an AUC of 0.73 (95% CI: 0.65–0.81) in patients younger than 75 years of age. Assuming the prevalence of cancer to be 5%, the score shows that if a patient fulfills all 3 score points, the probability of active cancer is 53%. Conclusions: Active cancer was found in 5% of our ischemic stroke patients. We found that a clinical score comprising elevated D-dimer ≥3 mg/L, lower Hb ≤12.0 g/dL and previous or current smoking is feasible for predicting active cancer in ischemic stroke patients.

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Section: Introductionmentioning

confidence: 99%

When to Screen Ischaemic Stroke Patients for Cancer

et al. 2018

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“…In addition, the multivariate analysis demonstrated that elevated levels of both FIB and D-dimer were independent risk factors for NHLAIS. However, elevated levels of FIB and D-dimer are reported to be biomarkers of the hypercoagulable state seen in patients with cancer [2,6], the pathogenesis of which has also been reported by several studies related to ischemic stroke [6,18,20,21]. Furthermore, Seok and colleagues [22] found an elevated D-dimer level linearly correlates to the frequency of microembolic signals in the internal carotid on transcranial Doppler ultrasound in cancer patients and patients with cryptogenic stroke.…”

Section: Resultsmentioning

confidence: 77%

Profiling of the Risk Factors and Designing of a Model to Identify Ischemic Stroke in Patients with Non-Hodgkin Lymphoma: A Multicenter Retrospective Study

et al. 2020

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Background: The occurrence of ischemic stroke in patients with non-Hodgkin lymphoma (NHL) is not well understood. This study aimed to determine independent risk factors to identity ischemic stroke in non-Hodgkin lymphoma-associated ischemic stroke (NHLAIS) patients. Methods: This retrospective study was conducted on NHLAIS patients and ageand gender-matched NHL patients. We collected clinical data of patients in both groups and used multiple logistic regression analysis to identify independent risk factors for NHLAIS. A receiver operating characteristic (ROC) analysis was used to establish an identification model based on po-tential risk factors of NHLAIS. Results: Sixty-three NHLAIS patients and 63 NHL patients were enrolled. Stage III/IV (58/63, 92.1%) and multiple arterial infarcts (44/63, 69.8%) were common among NHLAIS patients. Notably, NHLAIS patients had higher levels of serum fibrinogen (FIB), D-dimer, and ferritin (SF) and prolonged thromboplastin time and prothrombin time (PT) compared with NHL patients (all p < 0.05). Elevated FIB, D-dimer, and SF and prolonged PT were independent risk factors for NHLAIS. The area under the ROC curve of the identification model of NHLAIS patients was largest compared to that of other risk factors (0.838, 95% confidence interval: 0.759-0.899) (p < 0.05). Conclusion: This study reveals that elevated serum FIB, D-dimer, and SF and prolonged PT are potential independent risk factors of NHLAIS. The identification model established in this study may help monitor NHL patients who are at high risk of developing NHLAIS.

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“…16 The incidence of stroke as an initial manifestation of cancer varies in different studies and ranges from 0.4% to 10%. 6,17 Strokes are most commonly associated with lung cancer but have occurred in other cancers as well. 6,17 In patients with advanced adenocarcinoma, the risk of stroke recurrence is high.…”

Section: Discussionmentioning

confidence: 99%

“…6,17 Strokes are most commonly associated with lung cancer but have occurred in other cancers as well. 6,17 In patients with advanced adenocarcinoma, the risk of stroke recurrence is high. 18 Factors that increase stroke risk in patients with cancer are Trousseau's syndrome, non-bacterial thrombotic endocarditis, disseminated intravascular coagulation, coagulopathies, changes in blood viscosity, leukocytosis, radiotherapy, and anticancer drugs.…”

Section: Discussionmentioning

confidence: 99%

“…5 Cancers associated with a higher incidence of stroke are lung, pancreatic, and colorectal cancers. 3,6 VTE disease (pulmonary embolism [PE] and deep vein thrombosis [DVT]) are significantly associated with ovarian cancer 7 and adversely impact patient survival. [7][8][9][10] This case report outlines the discovery of occult ovarian cancer in a patient who exhibited acute cerebrovascular events with an incidental detection of patent foramen ovale (PFO).…”

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confidence: 99%

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Ovarian Cancer Presenting as Cryptogenic Stroke from Patent Foramen Ovale

Potugari

Priyanka²,

Komanapalli

et al. 2019

Clin Med Res

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A woman, aged 52 years, experienced severe headache, confusion, nausea, dizziness, and diplopia for three days. Magnetic resonance imaging of the brain showed multiple acute and subacute infarcts suggestive of embolic events. Dermatological examination was notable for splinter hemorrhages and macular patches on the fingernails and feet, respectively. Further diagnostic imaging of the chest and abdomen revealed pulmonary emboli and an ovarian mass with omental deposits and splenic infarcts. Fine-needle aspiration cytology and surgery confirmed a diagnosis of high-grade serous adenocarcinoma of the ovary with clear cell features. Extensive evaluation for malignancy should be considered on a case-by-case basis for patients with thromboembolic disease and an initial negative diagnostic evaluation for stroke. Consideration of patent foramen ovale closure is reasonable in patients with malignancy who are at risk for recurrent strokes.

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Plasma D‐dimer levels and ischaemic lesions in multiple vascular regions can predict occult cancer in patients with cryptogenic stroke

Abstract: High plasma D-dimer levels and lesions in multiple vascular regions can be used to predict occult cancer in patients with cryptogenic stroke.

Cited by 63 publications

References 28 publications

When to Screen Ischaemic Stroke Patients for Cancer

When to Screen Ischaemic Stroke Patients for Cancer

Profiling of the Risk Factors and Designing of a Model to Identify Ischemic Stroke in Patients with Non-Hodgkin Lymphoma: A Multicenter Retrospective Study

Ovarian Cancer Presenting as Cryptogenic Stroke from Patent Foramen Ovale

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