Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jul 1;83(1):26-33.
doi: 10.1212/WNL.0000000000000539. Epub 2014 May 21.

Recurrent thromboembolic events after ischemic stroke in patients with cancer

Babak B Navi  1 , Samuel Singer  2 , Alexander E Merkler  2 , Natalie T Cheng  2 , Jacqueline B Stone  2 , Hooman Kamel  2 , Costantino Iadecola  2 , Mitchell S V Elkind  2 , Lisa M DeAngelis  2
Affiliations

Recurrent thromboembolic events after ischemic stroke in patients with cancer

Babak B Navi et al. Neurology. .

Abstract

Objective: To determine the cumulative rate and characteristics of recurrent thromboembolic events after acute ischemic stroke in patients with cancer.

Methods: We retrospectively identified consecutive adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary-care cancer center from 2005 through 2009. Two neurologists independently reviewed all electronic records to ascertain the composite outcome of recurrent ischemic stroke, myocardial infarction, systemic embolism, TIA, or venous thromboembolism. Kaplan-Meier statistics were used to determine cumulative outcome rates. In exploratory analyses, Cox proportional hazard analysis was used to evaluate potential independent associations between a priori selected clinical factors and recurrent thromboembolic events.

Results: Among 263 study patients, complete follow-up until death was available in 230 (87%). Most patients had an adenocarcinoma as their underlying cancer (60%) and had systemic metastases (69%). Despite a median survival of 84 days (interquartile range 24-419 days), 90 patients (34%; 95% confidence interval 28%-40%) had 117 recurrent thromboembolic events, consisting of 57 cases of venous thromboembolism, 36 recurrent ischemic strokes, 13 myocardial infarctions, 10 cases of systemic embolism, and one TIA. Kaplan-Meier rates of recurrent thromboembolism were 21%, 31%, and 37% at 1, 3, and 6 months, respectively; cumulative rates of recurrent ischemic stroke were 7%, 13%, and 16%. Adenocarcinoma histology (hazard ratio 1.65, 95% confidence interval 1.02-2.68) was independently associated with recurrent thromboembolism.

Conclusions: Patients with acute ischemic stroke in the setting of active cancer (especially adenocarcinoma) face a substantial short-term risk of recurrent ischemic stroke and other types of thromboembolism.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Cumulative rate of recurrent thromboembolism in patients with cancer and acute ischemic stroke
Kaplan-Meier plot of survival free of recurrent thromboembolic events defined as a composite of any recurrent ischemic stroke, TIA, myocardial infarction, systemic embolism, deep vein thrombosis, or pulmonary embolism.
Figure 2
Figure 2. Cumulative rate of recurrent ischemic stroke in patients with cancer and acute ischemic stroke
Kaplan-Meier plot of survival free of recurrent ischemic stroke.
Figure 3
Figure 3. Cumulative rate of recurrent thromboembolism stratified by adenocarcinoma histology in patients with cancer and stroke
Kaplan-Meier plot of survival free of recurrent thromboembolic events, stratified by adenocarcinoma histology. Recurrent thromboembolic events were defined as a composite of recurrent ischemic stroke, TIA, myocardial infarction, systemic artery thrombosis, deep vein thrombosis, or pulmonary embolism.
See this image and copyright information in PMC

Comment in

References

    1. Bick RL. Cancer-associated thrombosis. N Engl J Med 2003;349:109–111 - PubMed
    1. Prandoni P, Falanga A, Piccioli A. Cancer and venous thromboembolism. Lancet Oncol 2005;6:401–410 - PubMed
    1. Sack GH, Jr, Levin J, Bell WR. Trousseau's syndrome and other manifestations of chronic disseminated coagulopathy in patients with neoplasms: clinical, pathophysiologic, and therapeutic features. Medicine 1977;56:1–37 - PubMed
    1. Dammacco F, Vacca A, Procaccio P, Ria R, Marech I, Racanelli V. Cancer-related coagulopathy (Trousseau's syndrome): review of the literature and experience of a single center of internal medicine. Clin Exp Med 2013;13:85–97 - PubMed
    1. Graus F, Rogers LR, Posner JB. Cerebrovascular complications in patients with cancer. Medicine 1985;64:16–35 - PubMed

Publication types