The Risk Factors for Death within 6 Months After Ischemic Stroke in Patients with Cancer

Tsuchihashi, Yoko; Shimizu, Takahiro; Akiyama, Hisanao; Hagiwara, Yuta; Soga, Kaima; Takao, Naoki; Uchino, Kenji; Yanagisawa, Toshiyuki; Yamauchi, Junji; Sato, Tomoo; Hasegawa, Yasuhiro; Yamano, Yoshihisa

doi:10.1016/j.jstrokecerebrovasdis.2020.105365

Cited by 6 publications

(12 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…Prior studies have reported that elevated D‐dimer predicts for early neurological deterioration, recurrent AIS, and death among patients with cancer‐related stroke 10,13–16 . Other hematologic biomarkers previously associated with adverse clinical outcomes among patients with cancer‐plus‐stroke include low fibrinogen, low hemoglobin, high C‐reactive protein, high or low platelet count, and a high neutrophil‐lymphocyte ratio 11,14–16,24 . In terms of clinical characteristics, a multiterritory infarct pattern on brain imaging, the presence of metastases, traditionally aggressive cancer types (pancreatic, gastric, and esophageal), high NIH Stroke Scale, and concurrent deep vein thrombosis have been associated with worse clinical outcomes (particularly death) in cancer‐plus‐stroke patients 10,12–14,25 .…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14][15][16] The markers with the most supportive data for associations with adverse clinical outcomes are plasma D-dimer and multiterritory infarct patterns on brain imaging. 10,[13][14][15][16] A prospective Korean study of 37 patients with cancer and cryptogenic AIS reported that transcranial Doppler (TCD) microemboli and comorbid venous thromboembolism were associated with reduced survival. 12 More high-quality prospective data on prognostic biomarkers are needed for clinicians to manage and counsel patients with cancerrelated AIS.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the recent interest in patients with cancer and AIS, few data exist on prognostic biomarkers in this population and most published studies were retrospective or restricted to homogeneous Asian cohorts 10–16 . The markers with the most supportive data for associations with adverse clinical outcomes are plasma D‐dimer and multiterritory infarct patterns on brain imaging 10,13–16 .…”

Section: Introductionmentioning

confidence: 99%

“…11,[14][15][16]24 In terms of clinical characteristics, a multiterritory infarct pattern on brain imaging, the presence of metastases, traditionally aggressive cancer types (pancreatic, gastric, and esophageal), high NIH Stroke Scale, and concurrent deep vein thrombosis have been associated…”

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confidence: 99%

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Ischemic stroke with cancer: Hematologic and embolic biomarkers and clinical outcomes

Navi

Zhang

Sherman

et al. 2022

Journal of Thrombosis and Haemostasis

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Background: Patients with cancer and acute ischemic stroke (AIS) face high rates of recurrent thromboembolism or death.Objectives: To examine whether hematologic and embolic biomarkers soon after AIS are associated with subsequent adverse clinical outcomes. Methods:We prospectively enrolled 50 adults with active solid tumor cancer and AIS at two hospitals from 2016 to 2020. Blood was collected 72-120 h after stroke onset.A 30-min transcranial Doppler (TCD) microemboli detection study was performed.The exposure variables were hematologic markers of coagulation (D-dimer, thrombinantithrombin), platelet (P-selectin), and endothelial activation (thrombomodulin, soluble intercellular adhesion molecule-1 [sICAM-1], soluble vascular cell adhesion molecule-1 [sVCAM-1]), and the presence of TCD microemboli. The primary outcome was a composite of recurrent arterial/venous thromboembolism or death. We used Cox regression to evaluate associations between biomarkers and subsequent outcomes. Results:During an estimated median follow-up time of 48 days (IQR, 18-312), 43 (86%) participants developed recurrent thromboembolism or death, including 28 (56%) with recurrent thromboembolism, of which 13 were recurrent AIS (26%). In unadjusted analysis, D-dimer (HR 1.6; 95% CI 1.2-2.0), P-selectin (HR 1.9; 95% CI 1.4-2.7), sICAM-1 (HR 2.2; 95% CI 1.6-3.1), sVCAM-1 (HR 1.6; 95% CI 1.2-2.1), and microemboli (HR 2.2; 95% CI 1.1-4.5) were associated with the primary outcome, whereas thrombin-antithrombin and thrombomodulin were not. D-dimer was the only marker associated with recurrent AIS (HR 1.2; 95% CI 1.0-1.5). Results were generally consistent in analyses adjusted for important prognostic variables.Conclusions: Markers of hypercoagulability and embolic disease may be associated with adverse clinical outcomes in cancer-related stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Ischemic stroke with cancer: Hematologic and embolic biomarkers and clinical outcomes

Navi

Zhang

Sherman

et al. 2022

Journal of Thrombosis and Haemostasis

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Cardiovascular outcomes and mortality after incident ischaemic stroke in patients with a recent cancer history

Akyea¹,

Iyen²,

Georgiopoulos³

et al. 2023

European Journal of Internal Medicine

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Malignancy‐associated ischemic stroke: Implications for diagnostic and therapeutic workup

Xie,

Hsu,

Lin

et al. 2024

CNS Neurosci Ther

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BackgroundPatients with malignancies have an increased risk of suffering ischemic stroke via several mechanisms such as coagulation dysfunction and other malignancy‐related effects as well as iatrogenic causes. Moreover, stroke can be the first sign of an occult malignancy, termed as malignancy‐associated ischemic stroke (MAS). Therefore, timely diagnostic assessment and targeted management of this complex clinical situation are critical.FindingsPatients with both stroke and malignancy have atypical ages, risk factors, and often exhibit malignancy‐related symptoms and multiple lesions on neuroimaging. New biomarkers such as eicosapentaenoic acid and blood mRNA profiles may help in distinguishing MAS from other strokes. In terms of treatment, malignancy should not be considered a contraindication, given comparable rates of recanalization and complications between stroke patients with or without malignancies.ConclusionIn this review, we summarize the latest developments in diagnosing and managing MAS, especially stroke with occult malignancies, and provide new recommendations from recently emerged clinical evidence for diagnostic and therapeutic workup strategies.

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The Risk Factors for Death within 6 Months After Ischemic Stroke in Patients with Cancer

Cited by 6 publications

References 21 publications

Ischemic stroke with cancer: Hematologic and embolic biomarkers and clinical outcomes

Ischemic stroke with cancer: Hematologic and embolic biomarkers and clinical outcomes

Cardiovascular outcomes and mortality after incident ischaemic stroke in patients with a recent cancer history

Malignancy‐associated ischemic stroke: Implications for diagnostic and therapeutic workup

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