D-dimer and C-reactive Protein as Potential Biomarkers for Diagnosis of Trousseau's Syndrome in Patients with Cerebral Embolism

Tsushima, Megumi; Metoki, Norifumi; Hagii, Joji; Saito, Shin; Shiroto, Hiroshi; Yasujima, Minoru; Kato, Tomo; Kudo, Naoko; Toyama, Yuichi; Yokono, Yoshikazu; Nozaka, Masashi; Kawamura, Yosuke; Nakata, Michi; Tomita, Hirofumi

doi:10.1016/j.jstrokecerebrovasdis.2019.104534

Cited by 25 publications

(16 citation statements)

References 25 publications

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“…The mechanisms of malignant tumor-related AIS include hypercoagulability, NBTE, infection, tumor-related chemotherapy, endocrine therapy, and radiotherapy, among which, hypercoagulability plays the most important role. This study found that increased levels of D-dimer and TAT are independent prognostic factors of such patients, which is consistent with the results of previous studies ( 32 ). Results of this study also confirmed that hypercoagulation may be the major mechanism of cerebral infarction in patients with a malignant tumor.…”

Section: Discussionsupporting

confidence: 93%

“…The results showed no significant difference between good and poor prognosis groups in common risk factors of AIS This study found that increased levels of D-dimer and TAT are independent prognostic factors of such patients, which is consistent with the results of previous studies (32). Results of this study also confirmed that hypercoagulation may be the major mechanism of cerebral infarction in patients with a malignant tumor.…”

Section: Prognostic Factors In Patients With Gastrointestinal Malignant Tumor-related Aissupporting

confidence: 91%

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Clinical Features and Prognostic Factors of Acute Ischemic Stroke Related to Malignant Gastrointestinal Tumor

Liu

Song

et al. 2021

Front. Neurol.

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Objectives: To analyze the clinical and imaging features of acute ischemic stroke (AIS) related to gastrointestinal malignant tumor, and to explore the prognostic factors.Methods: Clinical data of consecutive patients with gastrointestinal malignant tumor complicated with AIS admitted to the Department of Neurology and Oncology in Lanzhou University Second Hospital from April 2015 to April 2019 were retrospectively analyzed. Patients were divided into good prognosis (mRS 0–2) and poor prognosis (mRS > 2) based on a 90-day mRS score after discharge. The multivariate logistic regression model was used to analyze the prognostic factors.Results: A total of 68 patients were enrolled with an average age of 61.78 ± 6.65 years, including 49 men (72.06%). There were 18 patients in the good prognosis group and 50 patients in the poor prognosis group. The univariate analysis showed that Hcy, D-dimer, thrombin–antithrombin complex (TAT), and three territory sign in magnetic resonance imaging (MRI) were the risk factors for poor prognosis. Multivariate analysis showed that increased D-dimer (OR 4.497, 95% CI 1.014–19.938) and TAT levels (OR 4.294, 95% CI 1.654–11.149) were independent risk factors for the prognosis in such patients.Conclusion: Image of patients with gastrointestinal malignant tumor-related AIS is characterized by three territory sign (multiple lesions in different vascular supply areas). Increased TAT and D-dimer levels are independent prognostic risk factors. TAT is more sensitive to predict prognosis than D-dimer.

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Section: Discussionsupporting

confidence: 93%

Section: Prognostic Factors In Patients With Gastrointestinal Malignant Tumor-related Aissupporting

confidence: 91%

Clinical Features and Prognostic Factors of Acute Ischemic Stroke Related to Malignant Gastrointestinal Tumor

Liu

Song

et al. 2021

Front. Neurol.

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“…In a subgroup analysis of the Clopidogrel in high-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial, which enrolled patients with minor noncardioembolic stroke or transient ischemic attack, high NIHSS score (2-3) was associated with stroke recurrence within 90 days after treatment with dual antiplatelet therapy 38) . Our data also indicated that high D-dimer levels were related to in-hospital stroke recurrence, possibly because an underlying specific pathogenesis refractory to antiplatelet therapy, such as coagulopathy or Trousseau syndrome, might be present in cryptogenic stroke patients with such clinical features 39,40) . On the other hand, there is little or no evidence on secondary prevention in stroke patients with ASA, although treatment with anticoagulants may be a reasonable approach to dissolve the thrombus or prevent fibrin adherence to the septal wall.…”

Section: Advance Publication Journal Of Atherosclerosis and Thrombosismentioning

confidence: 53%

Atrial Septal Aneurysm may Cause In-Hospital Recurrence of Cryptogenic Stroke

Kuriki

Ueno

Kamiya

et al. 2021

JAT

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Aims: Awareness of potentially embologenic diseases is critical to determining the prognosis of cryptogenic stroke. The clinical significance of atrial septal aneurysm (ASA) in cryptogenic stroke has not been fully studied. Therefore, we explored clinical characteristics and in-hospital recurrence in patients with ASA in cryptogenic stroke. Methods: A multicenter observational registry of cryptogenic stroke patients was conducted. We obtained baseline characteristics, radiological and laboratory findings, and echocardiographic findings, especially of embolic sources on transesophageal echocardiography. The CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for embolic stroke of undetermined source/cryptogenic stroke) registry was recorded at http://www.umin.ac.jp/ctr/ (UMIN000032957). Patients’ clinical characteristics were compared according to the presence of ASA, and factors associated with in-hospital stroke recurrence were assessed. Results: The study included 671 patients (age, 68.7±12.7 years; 450 males; median National Institutes of Health Stroke Scale score, 2). ASA was detected in 92 patients (14%), displaying higher age (72.4±11.0 vs. 68.1 ±12.9 years, p =0.004), reduced frequency of diabetes mellitus (16% vs. 27%, p =0.030), higher frequency of right-to-left shunt (66% vs. 45%, p ＜0.001), and in-hospital stroke recurrence (8% vs. 3%, p =0.034). ASA was relatively associated with in-hospital recurrence (odds ratio 2.497, 95% confidence interval 0.959–6.500, p = 0.061). Conclusions: The CHALLENGE ESUS/CS registry indicated that ASA was not rare in cryptogenic stroke, and ASA’s clinical characteristics included higher age, reduced frequency of diabetes mellitus, and increased frequency of concomitant right-to-left shunt. ASA may be related to in-hospital stroke recurrence in cryptogenic stroke.

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“…Subsequently, effective anticancer therapy improved the coagulation abnormalities and led to the patient being in good condition during the one-year follow-up. Compared to patients with other types of cerebral infarction, including larger-artery atherosclerosis, cardioembolism, small-artery occlusion and ESUS, patients with CRIS had the highest levels of plasma D-dimer, CRP and FDP [19,20]. High serum D-dimer levels were associated with early neurological deterioration, stroke relapse and poor prognosis, with a median survival of 4.5 months in CRIS patients [5,21].…”

Section: Discussionmentioning

confidence: 97%

EGFR-mutant NSCLC presenting with stroke and massive systemic embolization as the first manifestation: case report

et al. 2021

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Background Presentation with massive systemic embolization as the initial manifestation of occult malignancy is infrequent. The standard management of cancer-related arterial thromboembolism has not yet been established. Case presentation We described a case of Trousseau’s syndrome resulting in acute ischemic stroke concomitant with multiple embolizations in the spleen and kidney during oral administration of dabigatran for pulmonary embolism preceding the diagnosis of a malignant tumor. A cancer-related hypercoagulable state was suspected because the patient was admitted to the neurology department due to acute ischemic stroke with three territory infarcts on diffusion-weighted imaging (DWI) in the absence of identifiable conventional risk factors and brain vessel narrowing. The patient was subsequently diagnosed with epidermal growth factor receptor (EGFR) mutation–positive non-small-cell lung cancer (NSCLC) (stage IV) with pleural metastasis. Administration of low-molecular-weight heparin followed by long-term dabigatran under effective cancer therapy comprising gefitinib and subsequent chemotherapy did not cause stroke relapse during the 1-year follow-up. Conclusions This case suggests that cancer-related hypercoagulability should be considered an important etiology for stroke patients who develop unexplained disseminated acute cerebral infarction without conventional stroke risk factors, especially concomitant with multiple organ embolization. Novel oral anticoagulants may be an alternative therapy for the long-term management of cancer-related arterial thromboembolism under effective cancer therapy.

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D-dimer and C-reactive Protein as Potential Biomarkers for Diagnosis of Trousseau's Syndrome in Patients with Cerebral Embolism

Cited by 25 publications

References 25 publications

Clinical Features and Prognostic Factors of Acute Ischemic Stroke Related to Malignant Gastrointestinal Tumor

Clinical Features and Prognostic Factors of Acute Ischemic Stroke Related to Malignant Gastrointestinal Tumor

Atrial Septal Aneurysm may Cause In-Hospital Recurrence of Cryptogenic Stroke

EGFR-mutant NSCLC presenting with stroke and massive systemic embolization as the first manifestation: case report

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