Differentiation of cancer from atrial fibrillation in patients with acute multifocal stroke

Ito, Shinji; Ueda, Akihiro; Murate, Kenichiro; Hirota, S.; Fukui, Takao; Ishikawa, Tomomasa; Shima, Sayuri; Hikichi, Chika; Mizutani, Yasuaki; Kizawa, Madoka; Asakura, Koichi; Mutoh, Tatsuro

doi:10.1016/j.jns.2016.07.054

Cited by 13 publications

(15 citation statements)

References 14 publications

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“…In the previous study, hypercoagulability with resistance to anticoagulation therapy in patients with both stroke and active cancer was associated with their poor prognosis ( 11 ). Furthermore, we found that the effect of anticoagulation therapy reduced D-dimer levels during the sub-acute phase in patients with Af alone, whereas D-dimer levels increased during the sub-acute phase and remained elevated despite anticoagulation therapy in TS patients ( 10 ). Thus, serial measurements of D-dimer levels in TS patients may be useful for diagnosing TS patients as well as for evaluating the efficacy of anticoagulant therapy.…”

Section: Introductionmentioning

confidence: 85%

“…However, various cut-off values of D-dimer levels have been reported for the differential diagnosis of TS patients ( 2 , 7 , 8 ). We recently reported that a D-dimer level ≥2.0 μg/mL was a useful diagnostic marker of TS, compared with patients with atrial fibrillation (Af) alone as a control group based upon Af being the major cause of AMEI ( 10 ). In the previous study, hypercoagulability with resistance to anticoagulation therapy in patients with both stroke and active cancer was associated with their poor prognosis ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Changes in Serial D-Dimer Levels Predict the Prognoses of Trousseau's Syndrome Patients

et al. 2018

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Background: The development of acute multiple embolic infarctions (AMEI) resulting from cancer is known as Trousseau's syndrome (TS). At present, however, there is no good marker for predicting the prognosis of TS patients. In the present study, we evaluated the use of serial D-dimer levels as a prognostic marker for TS.Methods: This retrospective cohort study included 1,409 consecutive acute ischemic stroke patients. We selected a group of patients with TS showing AMEI (n = 38; TS group) and a group of patients with atrial fibrillation (Af) and AMEI (n = 35; Af group) as controls. Serial D-dimer levels were measured between days 7 and 28 after stroke (sub-acute phase) in 21 patients of the TS group and 24 patients of the Af group.Results: D-dimer levels at onset (acute phase) were significantly higher in the TS group (8.45 ± 1.79 μg/mL, n = 38) compared with the Af group (1.14 ± 0.14 μg/mL, n = 35) (p < 0.0001). In patients for whom serial D-dimer measurements were made, D-dimer levels measured at the sub-acute phase decreased to 0.48 ± 0.12 μg/mL (n = 24) in the Af group, but remained elevated in the TS group during the sub-acute phase (11.20 ± 2.77 μg/mL, n = 21) (p < 0.0001). In all TS patients in whom serial D-dimer measurements were made, D-dimer levels in 17 patients who died within 500 days (13.31 ± 3.23 μg/mL) were significantly higher than those of the four surviving patients (2.23 ± 0.38 μg/mL) (cut-off D-dimer level = 3.0 μg/mL) during this period. Moreover, serial D-dimer levels of 10 patients who died within 90 days (17.78 ± 4.60 μg/mL) were significantly higher than those of the 11 patients who survived up to 90 days (5.21 ± 2.12 μg/mL) (p < 0.05).Conclusions: Serial D-dimer levels may be a good biomarker for TS as well as a useful predictor of the prognosis of TS patients.

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Section: Introductionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Changes in Serial D-Dimer Levels Predict the Prognoses of Trousseau's Syndrome Patients

et al. 2018

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“…In addition, elevated plasma D-dimer, fibrin degradation product (FDP), brain natriuretic peptide (BNP), fibrinogen, and C-reactive protein (CRP) levels are known to be biomarkers of cancer-related stroke [11,12,30]. Based on this finding, Ito et al [31] successfully differentiated cancer-related stroke using elevated plasma D-dimer levels from atrial fibrillation-related acute multifocal embolic stroke, but it was still necessary to determine whether substantiated cancer-related stroke had specific biomarkers. In the present study, KCS patients showed elevated plasma D-dimer, CA125 and CEA levels, and increased urine protein levels, which might be distinct clinical features of KCS patients, or they may be biomarkers of KCS, indicating that elevated plasma CA125 and CEA levels, together with increased proteinuria levels, may also be used to differentiate KCS from other types of cancer-related stroke or other conventional 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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“…A previous study observed fewer vascular risk factors and higher D-dimer levels in cryptogenic stroke patients with active cancer, [ 22 ] and the frequency of microembolic signals on transcranial Doppler images correlated linearly with D-dimer levels in this population. [ 10 ] In 2016, Ito et al [ 14 ] successfully used elevated plasma D-dimer levels to differentiate cancer-related stroke from atrial fibrillation-related acute multifocal embolic stroke, and a recent research identified D-dimer as a predictor of early neurologic deterioration in cryptogenic stroke with active cancer. [ 15 ] The association of D-dimer with hypercoagulability suggests that cancer-specific hypercoagulability is the main mechanism underlying cancer-related ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…This marker was previously found to correlate significantly with disease activity and prognosis in many cases of cancer-related stroke. [ 3 , 4 ] A recent study was the first to distinguished cancer-associated acute multifocal embolic infarction from atrial fibrillation using a D-dimer cut-off level of ≥2.0 μg/mL, [ 14 ] while another study investigated the potential of the D-dimer level as a predictor of early neurologic deterioration in patients with active cancer and recurrent thromboembolic stroke. [ 15 ] The levels of high-sensitivity C-reactive protein, fibrinogen, and probrain natriuretic peptide have also been identified as potential biomarkers of cancer-related stroke.…”

Section: Introductionmentioning

confidence: 99%

Biomarkers of gastric cancer-related ischemic stroke and its underlying pathogenesis

et al. 2018

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This study aimed to investigate the biomarkers and underlying pathogenesis of ischemic stroke in patients with gastric cancer (GC).Patients with active gastric cancer who had experienced acute ischemic stroke without conventional vascular risk factors (gastric cancer-related stroke [GCS] group) and visited The First Affiliated Hospital of Guangxi Medical University and First Affiliated Hospital of Sun Yat-sen University from January 2003 to December 2016 were retrospectively enrolled. The patients’ clinical features and laboratory findings were compared with those of age-, sex-, and disease progression-matched patients with GC without ischemic stroke (GC group) who had been admitted to the same hospital during the same period (GCS:GC ratio = 1:2).Among the 9166 patients diagnosed with GC, 70 had experienced a cerebral infarction and were enrolled in this study. Among them, 53 (75.71%) harbored multiple lesions in multiple vascular territories. Notably, patients in the GCS group exhibited significant increases in the D-dimer and cancer antigen 125 (CA125) levels and platelet-to-neutrophil ratio (PNR), compared to their counterparts in the GC group. A multiple logistic regression analysis identified all 3 factors as independent risk factors for cerebral infarction in patients with GC (D-dimer, odds ratio [OR] = 1.006 per 1 ng/mL increase, 95% confidence interval [CI], 1.004–1.009, P = .000; CA125, OR = 1.016 per 1 U/mL increase, 95% CI, 1.005–1.027, P = .005; PNR, OR = 1.025 per 1 point increase, 95% CI: 1.003–1.048, P = .023).Elevated plasma D-dimer and CA125 levels and an increased PNR might affect the occurrence of GC-related ischemic stroke and could therefore serve as potential biomarkers.

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Differentiation of cancer from atrial fibrillation in patients with acute multifocal stroke

Cited by 13 publications

References 14 publications

Changes in Serial D-Dimer Levels Predict the Prognoses of Trousseau's Syndrome Patients

Changes in Serial D-Dimer Levels Predict the Prognoses of Trousseau's Syndrome Patients

Potential Pathogenesis and Biomarkers of Kidney Cancer-Related Stroke

Biomarkers of gastric cancer-related ischemic stroke and its underlying pathogenesis

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