Ischemic stroke with cancer: Hematologic and embolic biomarkers and clinical outcomes Journal Article
| Authors: | Navi, B. B.; Zhang, C.; Sherman, C. P.; Genova, R.; LeMoss, N. M.; Kamel, H.; Tagawa, S. T.; Saxena, A.; Ocean, A. J.; Kasner, S. E.; Cushman, M.; Elkind, M. S. V.; Peerschke, E.; DeAngelis, L. M. |
| Article Title: | Ischemic stroke with cancer: Hematologic and embolic biomarkers and clinical outcomes |
| 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. © 2022 International Society on Thrombosis and Haemostasis. |
| Keywords: | neoplasms; biomarkers; stroke; thrombosis; thrombophilia |
| Journal Title: | Journal of Thrombosis and Haemostasis |
| Volume: | 20 |
| Issue: | 9 |
| ISSN: | 1538-7933 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2022-09-01 |
| Start Page: | 2046 |
| End Page: | 2057 |
| Language: | English |
| DOI: | 10.1111/jth.15779 |
| PUBMED: | 35652416 |
| PROVIDER: | scopus |
| PMCID: | PMC9378694 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 September 2022 -- Source: Scopus |
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