Risk Factor, Pattern, Etiology and Outcome in Ischemic Stroke Patients with Cancer: A Nested Case-Control Study

Abstract

Background: Coagulation disorders are seen in cancer patients, but it is not clear whether cancer predisposes stroke patients to unique characteristics. The aim of the study was to investigate risk factors, pattern,etiology and outcome in stroke patients with cancer. Methods: A retrospective review of all ischemic stroke (IS) patients with cancer (n = 56) admitted to Bankstown-Lidcombe Hospital, Sydney, Australia, between January 1999 and December 2004 was conducted and comparison made to age- and gender-matched noncancer IS patients admitted to the same hospital during the same period. Results: Vascular risk factors and stroke pattern were comparable in cancer and noncancer groups. Poststroke thrombotic episodes (myocardial infarction, deep vein thrombosis or pulmonary emboli) were more common in the cancer group than in the noncancer group (11 vs. 0%, p = 0.031). Depression was also more common in the cancer group than in the noncancer group (14 vs. 2%, p = 0.039). There was a tendency for more patients in the cancer group to die in hospital (30 vs. 14%, p = 0.078). Conclusions: Coagulation disorders were more likely to be seen in stroke cancer patients, and patients with cancer tended to have a higher in-hospital poststroke mortality. Larger sample size studies may identify further differences in the characteristics of stroke patients with cancer.

Stroke and cancer: a review

“…However, Zhang et al came to the conclusion that cancer patients with stroke have a more dismal prognosis, probably due to their general state and the concurrence of two severe diseases (10,11).…”

“…In this study, the risk of recurrent ischaemic events was also similar to that of the non-cancer population. Recent articles compare cancer patients with a non-cancer population by means of image-based classifications and common risk factors for stroke (7)(8)(9)(10)(11). Concerning the studies, they all suffer from referral bias, which is less marked in general hospitals than in cancer centres.…”

Ischemic Stroke in Cancer Patients With and Without Conventional Mechanisms

“…Previous studies reported that the stroke patterns and vascular risk factors in cancer patients were not significantly different compared with the general population. [5][6][7] Autopsy studies demonstrated that the most common cause of ischemic stroke (78% asymptomatic) in patients with cancer was atherosclerosis. 1 On the contrary, others reported that embolisms, not including those of cardiac origin, were the most common cause of ischemic stroke in cancer patients.…”

Stroke and Cancer

“…4,5 A small number of earlier studies on this topic generated conflicting results. [6][7][8][9][10][11][12] The largest study including 161 patients by Kim et al in 2010 differentiated between patients with cancer+stroke with and without conventional stroke etiologies and renewed the idea of cancer-associated hypercoagulation as an important stroke etiology. 13 Significantly higher d-dimer levels as well as a significantly higher rate of multiply affected vascular territories in the group of patients without conventional stroke etiology supported the idea of cancer-associated hypercoagulation with resulting cerebral embolism.…”