Ischemic stroke with cancer: Hematologic and embolic biomarkers and clinical outcomes. (21st June 2022)

• Record Type: Journal Article
• Authors: Navi, Babak B.; Zhang, Cenai; Sherman, Carla P.; Genova, Richard; LeMoss, Natalie M.; Kamel, Hooman; Tagawa, Scott T.; Saxena, Ashish; Ocean, Allyson J.; Kasner, Scott E.; Cushman, Mary; Elkind, Mitchell S. V.; Peerschke, Ellinor; DeAngelis, Lisa M.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 20:Number 9(2022)
• Page Start: 2046
• Page End: 2057
• Publication Date: 2022-06-21
• Subjects: biomarkers -- neoplasms -- stroke -- thrombophilia -- thrombosis; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.15779
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract: 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, 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, 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.