Ischemic Stroke with Cancer: Hematologic and Embolic Biomarkers and Clinical Outcomes

J Thromb Haemost. 2022 Jun 2. doi: 10.1111/jth.15779. Online ahead of print.


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 2016-2020. Blood was collected 72-120 hours after stroke onset. A 30-minute Transcranial Doppler (TCD) microemboli detection study was performed. The exposure variables were hematologic markers of coagulation (D-dimer, thrombin-antithrombin), 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, while 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.

PMID:35652416 | DOI:10.1111/jth.15779