Fatal Intracranial Hemorrhage after Intravenous Thrombolytic Therapy for Acute Ischemic Stroke Associated with Cancer-related Nonbacterial Thrombotic Endocarditis

Yagi, Takuya; Takahashi, Kie; Tanikawa, Mariko; Seki, Morinobu; Abe, Takato; Suzuki, Noriyuki

doi:10.1016/j.jstrokecerebrovasdis.2014.04.004

Cited by 14 publications

(9 citation statements)

References 13 publications

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“…Thus, the pure outcomes of cancer-associated stroke may be hard to interpret. Additionally, there have also been two case-series studies that reported on safety and hazardous events after use of t-PA in ischemic stroke with cancer [11, 12]. The cases that resulted in hazardous events occurred in patients with newly diagnosed cancer and high elevated D-dimer levels with nonbacterial thrombotic endocarditis, similar to our participants [11, 12].…”

Section: Discussionsupporting

confidence: 79%

“…Additionally, there have also been two case-series studies that reported on safety and hazardous events after use of t-PA in ischemic stroke with cancer [11, 12]. The cases that resulted in hazardous events occurred in patients with newly diagnosed cancer and high elevated D-dimer levels with nonbacterial thrombotic endocarditis, similar to our participants [11, 12]. In contrast, patients with fair outcomes were those with nonactive cancer status, defined as being stable after operation or in complete remission with regular treatment [12].…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Thrombolysis in Acute Ischemic Stroke with Active Cancer

Nam

Kim

et al. 2017

BioMed Research International

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Ischemic stroke patients with active cancer are known to have poor clinical outcomes. However, the efficacy and safety of intravenous alteplase (IV t-PA) in this group are still unclear. In this study, we aimed to evaluate whether stroke patients with cancer had poor clinical outcomes after use of IV t-PA. We reviewed ischemic stroke patients with active cancer treated with isolated IV t-PA between April 2010 and March 2015 at three national university hospitals from the registry for ischemic stroke in Korea. The clinical outcomes of early neurological deterioration (END), hemorrhagic transformation, in-hospital mortality, 3-month modified Rankin scale (mRS), the National Institutes of Health Stroke Scale (NIHSS) discharge score, and duration of hospitalization were compared. We enrolled a total of 12 patients, and the cohort showed poor outcomes including 4 (33%) END events, 7 (58%) hemorrhagic transformations, 3 (25%) in-hospital mortality cases, and 7 (58%) poor mRS (3–6) scores. Additionally, the cryptogenic stroke group (n = 6) more frequently had high mRS scores (P = 0.043) as well as tendencies for frequent END events, hemorrhagic transformations, in-hospital mortality cases, and higher discharge NIHSS scores without statistical significance. In conclusion, ischemic stroke patients with active cancer, especially those with a cryptogenic mechanism, showed poor clinical outcomes after use of IV t-PA.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Intravenous Thrombolysis in Acute Ischemic Stroke with Active Cancer

Nam

Kim

et al. 2017

BioMed Research International

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“…Cancer is not an established contraindication for IV-tPA, yet, due to lack of empirical evidence of the safety of IV-tPA in cancer patients, physicians have been hesitant to use it. Some cancer patients have coagulation disorders, some have thrombocytopenia, a relative contraindication, or even non-bacterial endocarditis, associated with hemorrhage ( 11 , 12 ). Although none of the present study's CS patients had thrombocytopenia, this might have been seen if the number of CS patients was higher.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Thrombolysis in Ischemic Stroke Patients With Active Cancer

2018

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Introduction: It has been difficult to state specific guidelines for IV-tPA use in cancer patients. Many of the randomized tPA-trials included too few patients with cancer or excluded patients with cancer entirely. In this report, we aimed to study the use of IV-tPA in patients with active cancer and acute ischemic stroke. We also investigated if the cancer patients who received IV-tPA experienced adverse events.Methods: All patients with ischemic stroke admitted to the Stroke Unit at Haukeland University Hospital were prospectively registered in the NORSTROKE database and every patient's medical record was searched for cancer diagnoses.Results: Of 1,646 patients admitted with ischemic stroke, 82 (5.0%) patients had active cancer. The total number of patients treated with IV-tPA was 16.2%. Five patients with stroke and active cancer were treated with IV-tPA (6.1%) and none suffered adverse events. Of the patients with no history of cancer, 261 (16.7%) were treated with IV-tPA and 3.8% experienced tPA-related adverse events.Conclusions: Few patients with active cancer receive thrombolysis for acute ischemic stroke. We report five cancer patients (three known and two occult) treated with IV-tPA for ischemic stroke without tPA-related adverse events.

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“…Occasionally, lung cancer cells have been found to directly cause thrombotic stroke by invading the left atrium, and kidney cells have been found to cause thrombotic stroke by invading the right inferior pulmonary vein [5,6]. In addition, cancer-related NBTE directly leading to thrombotic stroke has been documented [7,17]. Cancer patients with acute stroke often show no evidence that cancer cells directly cause stroke.…”

Section: Discussionmentioning

confidence: 99%

Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke

et al. 2017

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BackgroundStroke risk and stroke recurrence are increased in cancer patients, but the pathogenesis and biomarkers of kidney cancer-related stroke (KCS) are generally unclear. The aim of the present research was to investigate the pathogenesis and plasma biomarkers of kidney cancer-related stroke.Material/MethodsA retrospective review was conducted on acute stroke patients with kidney cancer (KC) who were admitted to the hospital between January 2006 and December 2015. A total of 106 patients with KCS (active KC patients with acute stroke but without conventional vascular risks) were identified. In addition, 106 age- and sex-matched patients with KC alone were recruited.ResultsKCS patients had higher plasma D-dimer, cancer antigen (CA) 125, and CEA levels and greater proteinuria levels than did KC patients. Multiple logistic regression analysis showed that the risk of stroke in patients with KC increased independently by 0.8% (odds ratio [OR] 1.008; 95% confidence interval [CI] 1.002, 1.013; p=0.004) with a 1 ng/mL increase in D-dimer levels, by 1.2% (OR 1.012; 95% CI 1.007, 1.018; p=0.000) with a 1 U/mL increase in CA125, by 2.5% (OR 1.025; 95% CI 1.012, 1.038; p=0.000) with a 1 U/mL increase in CEA by 1.4% (OR 1.014; 95% CI 1.005, 1.024; p=0.004) with a 1 mg increase in urine protein in 24 hours.ConclusionsElevated plasma D-dimer, CA125 and CEA levels, and increased urine protein levels might lead to hypercoagulability and then KCS; however, they may also be biomarkers of KCS.

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Fatal Intracranial Hemorrhage after Intravenous Thrombolytic Therapy for Acute Ischemic Stroke Associated with Cancer-related Nonbacterial Thrombotic Endocarditis

Cited by 14 publications

References 13 publications

Intravenous Thrombolysis in Acute Ischemic Stroke with Active Cancer

Intravenous Thrombolysis in Acute Ischemic Stroke with Active Cancer

Intravenous Thrombolysis in Ischemic Stroke Patients With Active Cancer

Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke

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