Anticoagulant versus antiplatelet treatment for secondary stroke prevention in patients with active cancer
Approximately 5-10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major bleeding. The optimal antithrombotic strategy for cancer-related stroke is uncertain. This study compared clinical outcomes among patients with...
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| Veröffentlicht in: | Frontiers in neurology Jg. 16; S. 1530775 |
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| Abstract | Approximately 5-10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major bleeding. The optimal antithrombotic strategy for cancer-related stroke is uncertain. This study compared clinical outcomes among patients with cancer-related stroke treated with anticoagulant versus antiplatelet therapy for secondary prevention.
We identified consecutive patients with AIS and active cancer hospitalized at our comprehensive stroke center from 2015 through 2020. Patients with cardioembolic mechanisms were excluded. We used Cox regression and inverse probability of treatment weighting (IPTW) analyses to evaluate the associations between type of antithrombotic therapy at discharge (anticoagulant versus antiplatelet therapy) and the main outcomes of 1-year mortality and long-term recurrent AIS.
Among 5,012 AIS patients, 306 had active cancer. After applying study eligibility criteria, we analyzed 135 patients (median age 72 years; 44% women), of whom 58 (43%) were treated with anticoagulant and 77 (57%) with antiplatelet therapy. The median follow-up time was 495 days (IQR, 57-1,029). Patients treated with anticoagulants, compared to patients treated with antiplatelet therapy, were younger (median 69 versus 75 years), had more metastatic disease (72% versus 41%), and higher median baseline D-dimer levels (median 8,536 μg/L versus 1,010 μg/L). Anticoagulant versus antiplatelet therapy was associated with similar risks of 1-year mortality (adjusted hazard ratio [aHR], 0.76; 95% confidence interval [CI], 0.36-1.63) and long-term recurrent AIS (aHR 0.49; 95% CI 0.08-2.83). The IPTW analyses for 1-year mortality confirmed the results of the main analyses (HR 0.82; 95%CI: 0.39-1.72,
= 0.61).
Factors associated with anticoagulant use in patients with cancer-related stroke include younger age, more advanced cancer, and elevated D-dimer. Similar outcomes were seen with anticoagulant versus antiplatelet therapy in these patients highlighting the need for future randomized trials to determine the preferred antithrombotic strategy. |
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| AbstractList | Approximately 5-10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major bleeding. The optimal antithrombotic strategy for cancer-related stroke is uncertain. This study compared clinical outcomes among patients with cancer-related stroke treated with anticoagulant versus antiplatelet therapy for secondary prevention.
We identified consecutive patients with AIS and active cancer hospitalized at our comprehensive stroke center from 2015 through 2020. Patients with cardioembolic mechanisms were excluded. We used Cox regression and inverse probability of treatment weighting (IPTW) analyses to evaluate the associations between type of antithrombotic therapy at discharge (anticoagulant versus antiplatelet therapy) and the main outcomes of 1-year mortality and long-term recurrent AIS.
Among 5,012 AIS patients, 306 had active cancer. After applying study eligibility criteria, we analyzed 135 patients (median age 72 years; 44% women), of whom 58 (43%) were treated with anticoagulant and 77 (57%) with antiplatelet therapy. The median follow-up time was 495 days (IQR, 57-1,029). Patients treated with anticoagulants, compared to patients treated with antiplatelet therapy, were younger (median 69 versus 75 years), had more metastatic disease (72% versus 41%), and higher median baseline D-dimer levels (median 8,536 μg/L versus 1,010 μg/L). Anticoagulant versus antiplatelet therapy was associated with similar risks of 1-year mortality (adjusted hazard ratio [aHR], 0.76; 95% confidence interval [CI], 0.36-1.63) and long-term recurrent AIS (aHR 0.49; 95% CI 0.08-2.83). The IPTW analyses for 1-year mortality confirmed the results of the main analyses (HR 0.82; 95%CI: 0.39-1.72,
= 0.61).
Factors associated with anticoagulant use in patients with cancer-related stroke include younger age, more advanced cancer, and elevated D-dimer. Similar outcomes were seen with anticoagulant versus antiplatelet therapy in these patients highlighting the need for future randomized trials to determine the preferred antithrombotic strategy. Approximately 5-10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major bleeding. The optimal antithrombotic strategy for cancer-related stroke is uncertain. This study compared clinical outcomes among patients with cancer-related stroke treated with anticoagulant versus antiplatelet therapy for secondary prevention.BackgroundApproximately 5-10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major bleeding. The optimal antithrombotic strategy for cancer-related stroke is uncertain. This study compared clinical outcomes among patients with cancer-related stroke treated with anticoagulant versus antiplatelet therapy for secondary prevention.We identified consecutive patients with AIS and active cancer hospitalized at our comprehensive stroke center from 2015 through 2020. Patients with cardioembolic mechanisms were excluded. We used Cox regression and inverse probability of treatment weighting (IPTW) analyses to evaluate the associations between type of antithrombotic therapy at discharge (anticoagulant versus antiplatelet therapy) and the main outcomes of 1-year mortality and long-term recurrent AIS.MethodsWe identified consecutive patients with AIS and active cancer hospitalized at our comprehensive stroke center from 2015 through 2020. Patients with cardioembolic mechanisms were excluded. We used Cox regression and inverse probability of treatment weighting (IPTW) analyses to evaluate the associations between type of antithrombotic therapy at discharge (anticoagulant versus antiplatelet therapy) and the main outcomes of 1-year mortality and long-term recurrent AIS.Among 5,012 AIS patients, 306 had active cancer. After applying study eligibility criteria, we analyzed 135 patients (median age 72 years; 44% women), of whom 58 (43%) were treated with anticoagulant and 77 (57%) with antiplatelet therapy. The median follow-up time was 495 days (IQR, 57-1,029). Patients treated with anticoagulants, compared to patients treated with antiplatelet therapy, were younger (median 69 versus 75 years), had more metastatic disease (72% versus 41%), and higher median baseline D-dimer levels (median 8,536 μg/L versus 1,010 μg/L). Anticoagulant versus antiplatelet therapy was associated with similar risks of 1-year mortality (adjusted hazard ratio [aHR], 0.76; 95% confidence interval [CI], 0.36-1.63) and long-term recurrent AIS (aHR 0.49; 95% CI 0.08-2.83). The IPTW analyses for 1-year mortality confirmed the results of the main analyses (HR 0.82; 95%CI: 0.39-1.72, p = 0.61).ResultsAmong 5,012 AIS patients, 306 had active cancer. After applying study eligibility criteria, we analyzed 135 patients (median age 72 years; 44% women), of whom 58 (43%) were treated with anticoagulant and 77 (57%) with antiplatelet therapy. The median follow-up time was 495 days (IQR, 57-1,029). Patients treated with anticoagulants, compared to patients treated with antiplatelet therapy, were younger (median 69 versus 75 years), had more metastatic disease (72% versus 41%), and higher median baseline D-dimer levels (median 8,536 μg/L versus 1,010 μg/L). Anticoagulant versus antiplatelet therapy was associated with similar risks of 1-year mortality (adjusted hazard ratio [aHR], 0.76; 95% confidence interval [CI], 0.36-1.63) and long-term recurrent AIS (aHR 0.49; 95% CI 0.08-2.83). The IPTW analyses for 1-year mortality confirmed the results of the main analyses (HR 0.82; 95%CI: 0.39-1.72, p = 0.61).Factors associated with anticoagulant use in patients with cancer-related stroke include younger age, more advanced cancer, and elevated D-dimer. Similar outcomes were seen with anticoagulant versus antiplatelet therapy in these patients highlighting the need for future randomized trials to determine the preferred antithrombotic strategy.ConclusionFactors associated with anticoagulant use in patients with cancer-related stroke include younger age, more advanced cancer, and elevated D-dimer. Similar outcomes were seen with anticoagulant versus antiplatelet therapy in these patients highlighting the need for future randomized trials to determine the preferred antithrombotic strategy. BackgroundApproximately 5–10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major bleeding. The optimal antithrombotic strategy for cancer-related stroke is uncertain. This study compared clinical outcomes among patients with cancer-related stroke treated with anticoagulant versus antiplatelet therapy for secondary prevention.MethodsWe identified consecutive patients with AIS and active cancer hospitalized at our comprehensive stroke center from 2015 through 2020. Patients with cardioembolic mechanisms were excluded. We used Cox regression and inverse probability of treatment weighting (IPTW) analyses to evaluate the associations between type of antithrombotic therapy at discharge (anticoagulant versus antiplatelet therapy) and the main outcomes of 1-year mortality and long-term recurrent AIS.ResultsAmong 5,012 AIS patients, 306 had active cancer. After applying study eligibility criteria, we analyzed 135 patients (median age 72 years; 44% women), of whom 58 (43%) were treated with anticoagulant and 77 (57%) with antiplatelet therapy. The median follow-up time was 495 days (IQR, 57–1,029). Patients treated with anticoagulants, compared to patients treated with antiplatelet therapy, were younger (median 69 versus 75 years), had more metastatic disease (72% versus 41%), and higher median baseline D-dimer levels (median 8,536 μg/L versus 1,010 μg/L). Anticoagulant versus antiplatelet therapy was associated with similar risks of 1-year mortality (adjusted hazard ratio [aHR], 0.76; 95% confidence interval [CI], 0.36–1.63) and long-term recurrent AIS (aHR 0.49; 95% CI 0.08–2.83). The IPTW analyses for 1-year mortality confirmed the results of the main analyses (HR 0.82; 95%CI: 0.39–1.72, p = 0.61).ConclusionFactors associated with anticoagulant use in patients with cancer-related stroke include younger age, more advanced cancer, and elevated D-dimer. Similar outcomes were seen with anticoagulant versus antiplatelet therapy in these patients highlighting the need for future randomized trials to determine the preferred antithrombotic strategy. |
| Author | Heldner, Mirjam R. Arnold, Marcel Venzin, Selina B. Jung, Simon Pabst, Thomas Mujanovic, Adnan Branca, Mattia Beyeler, Morin Göcmen, Jayan Seiffge, David J. Fischer, Urs Göldlin, Martina B. Bücke, Philipp Scutelnic, Adrian Kielkopf, Moritz C. Kaesmacher, Johannes Kamel, Hooman Boronylo, Anna Berger, Martin D. Navi, Babak B. Liberman, Ava L. Costamagna, Gianluca Meinel, Thomas R. Steinauer, Fabienne |
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| Cites_doi | 10.1016/S1474-4422(13)70310-7 10.1111/jth.14219 10.1042/BSR20130057 10.1093/ckj/sfab158 10.1016/j.jstrokecerebrovasdis.2022.106609 10.3174/ajnr.A4846 10.1016/j.jstrokecerebrovasdis.2017.05.031 10.1002/ana.26129 10.1177/17562864221106362 10.1002/ana.25227 10.1001/jamaneurol.2017.4211 10.1111/jth.15779 10.1161/01.str.24.1.35 10.1056/NEJMoa0804656 10.1161/01.STR.30.10.2101 10.1002/14651858.CD000187.pub2 10.3892/ijo.2019.4669 10.1002/brb3.2738 10.1016/j.jstrokecerebrovasdis.2012.11.016 10.1177/1747493020971104 10.5853/jos.2023.03279 10.1002/onco.13584 10.3390/jcm8091457 10.3389/fneur.2023.1148152 10.5853/jos.2016.00570 10.1002/ana.22050 10.4103/tcmj.tcmj_55_19 10.1177/17474930241260589 10.2188/jea.JE20210145 10.1111/ene.16200 10.1111/ene.14172 |
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| Keywords | cancer secondary prevention antithrombotic drugs embolic stroke of unknown source (ESUS) acute ischemic stroke |
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| Snippet | Approximately 5-10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major... BackgroundApproximately 5–10% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and... |
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| SubjectTerms | acute ischemic stroke antithrombotic drugs cancer embolic stroke of unknown source (ESUS) secondary prevention |
| Title | Anticoagulant versus antiplatelet treatment for secondary stroke prevention in patients with active cancer |
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