Intravenous Thrombolysis in Ischemic Stroke Patients With Active Cancer

Selvik, Henriette Aurora; Næss, Halvor; Kvistad, Christopher Elnan

doi:10.3389/fneur.2018.00811

Cited by 21 publications

(20 citation statements)

References 16 publications

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“…The safety of thrombolytic therapy for treating AIS in patients with cancer is still controversial; 10–18 however, the majority of previous studies suggest that rtPA may be able to be used safely in selected patients. Murthy et al.…”

Section: Discussionmentioning

confidence: 99%

Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding

Inohara

Kosinski

et al. 2019

European Stroke Journal

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Background: There are limited data on the safety of intravenous recombinant tissue plasminogen activator (rtPA) for treating acute ischemic stroke in patients with gastrointestinal malignancy or recent gastrointestinal bleeding within 21 days of their index stroke. Aims: To evaluate clinical outcomes in patients treated with rtPA for acute ischemic stroke who had gastrointestinal malignancy or recent gastrointestinal bleeding Methods: We identified patients who were treated with rtPA for acute ischemic stroke between 2/2009 and 12/2015 from the Get With The Guidelines-Stroke linked to Medicare claims data. Gastrointestinal malignancy and recent gastrointestinal bleeding were defined as any gastrointestinal malignancy hospitalisation within one year prior to acute ischemic stroke and gastrointestinal bleeding hospitalisation within 21 days prior to acute ischemic stroke, respectively. Outcomes of interest included in-hospital mortality and bleeding complications. Results: Among 40,396 patients aged 65 years or older treated with rtPA for acute ischemic stroke from 1522 sites (mean age [SD] 81.0 [8.1] years; 41.9% women), 136 (0.3%) had gastrointestinal malignancy (n ¼ 96) or recent gastrointestinal bleeding (n ¼ 43). Patients with gastrointestinal malignancy or bleeding had more severe stroke than those without (median NIHSS [interquartile range]: 14.

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Section: Discussionmentioning

confidence: 99%

Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding

Inohara

Kosinski

et al. 2019

European Stroke Journal

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“…7 Emerging reports have suggested that presence of cancer may be a potential effect modifier after tPA administration, especially in those with metastatic disease. 8,9 Yet, the patterns and safety of tPA use among contemporary AIS patients with underlying cancer, particularly in the absence of metastatic disease, are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Contemporary utilization patterns and outcomes of thrombolytic administration for ischemic stroke among patients with cancer

Owusu-Guha

Guha

Miller

et al. 2019

International Journal of Stroke

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Background Thrombolytic therapy significantly improves outcomes among patients with acute ischemic stroke. While cancer outcomes have dramatically improved, the utilization, safety, and mortality outcomes of patients with cancer who receive thrombolytic therapy for acute ischemic stroke are unknown. Methods Using a national database, we identified all hospitalizations for acute ischemic stroke requiring thrombolytic therapy between 2003 and 2015. Patients with contraindications to thrombolytic therapy were excluded. Following propensity score matching for comorbidity burden, trends in thrombolytic therapy use and its effect on in-hospital mortality, intracranial or all-cause bleeding, and the combined endpoint of mortality and all-cause bleeding, by presence/absence of cancer were evaluated. We also evaluated 30- and 90-day readmission rates post-thrombolytic therapy administration. Results We identified 237,687 acute ischemic stroke hospitalizations requiring thrombolytic therapy, of which 26,328 (11%) had an underlying cancer. Over the study period, thrombolytic therapy use increased across all acute ischemic stroke admissions, irrespective of cancer presence (12.4/1000 in 2003 to 81.1/1000 in 2015, P < 0.0001). However, thrombolytic therapy utilization differed by cancer presence (4.8% cancer vs.·5.1% non-cancer, P = 0.001). There was no difference in intracranial bleeding (9.6% vs. 9.7%), all-cause bleeding (13.2% vs. 13.2%), or in-hospital mortality (7.6% vs. 7.2%). While there was no difference in 30-day readmission rates by cancer presence (24% vs. 29%, P = 0.40), at 90-days, cancer patients saw higher readmission rates (17.2% vs. 13.3%, P = 0.02). Conclusions Contemporary thrombolytic therapy use for acute ischemic stroke has risen, irrespective of presence of cancer. Yet, patients with comorbid cancer appear to see lower rates of thrombolytic therapy use for acute ischemic stroke, despite no difference in the rate of intracranial bleeding or mortality after adjustment for comorbidities.

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“…[5][6][7][8][9] While emerging evidence from several cohort studies indicates that selective use of these acute revascularization strategies is generally safe in eligible patients with stroke with comorbid malignancy, most of these studies are limited by a small sample size, and none of them have enough granularity to provide data specific to the primary cancer type. [10][11][12][13][14][15] In this study, using a large nationally representative dataset, we sought to evaluate the in-hospital outcomes and recurrent ischemic strokes among patients hospitalized due to AIS with and without comorbid solid organ malignancy. We also aimed to study the clinical outcomes for the most prevalent primary malignancy types and the influence of acute stroke interventions on these outcomes.…”

Section: Discussionmentioning

confidence: 99%

In-Hospital Outcomes and Recurrence of Acute Ischemic Stroke in Patients With Solid Organ Malignancy

et al. 2022

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Objective:To evaluate the influence of solid organ malignancies on the in-hospital outcomes and recurrent strokes among patients hospitalized with acute ischemic stroke (AIS).Methods:Adult hospitalizations with a primary diagnosis of AIS were identified from the Nationwide Readmissions Database 2016-2018. Logistic regression was used to compare the differences in the utilization of acute stroke interventions and clinical outcomes in patients with and without malignancy. Survival analysis was used to evaluate the risk of readmission due to recurrent stroke after discharge.Results:There were 1385840 hospitalizations due to AIS (mean±SD age 70.4±14.0 years, female 50.2%). Of these, 50553 (3.7%) had a concurrent diagnosis of solid organ malignancy. The five most common malignancies included lung cancer (24.6%), prostate cancer (13.2%), breast cancer (9.3%), pancreatic cancer (6.5%), and colorectal cancer (6.2%). After adjustment for baseline differences, patients with malignancy were more likely to have intraparenchymal hemorrhage (IPH) [odds ratio (OR): 1.11, 95% confidence interval (CI): 1.04-1.19], in-hospital mortality (OR: 2.15, 95% CI: 2.04-2.28), and discharge disposition other than to home (OR: 1.70, 95% CI: 1.64-1.75). Patients with malignancy were less likely to receive intravenous thrombolysis (tPA) and were more likely to undergo mechanical thrombectomy (MT). Among the subgroups of patients treated with tPA or MT, the outcomes were comparable between patients with and without malignancy, except patients with lung cancer remained at a higher risk of mortality and adverse disposition despite these acute stroke interventions. Patients with malignancy were at a higher risk of readmission due to recurrent AIS within 1 year of discharge (hazards ratio: 1.18, 95% CI: 1.11-1.25), and this risk was specifically driven by the lung and pancreatic cancers.Conclusion:While patients with malignancy generally have worse in-hospital outcomes as compared to those without, there is considerable variation in these outcomes according to the different cancer types and the use of acute stroke interventions. The use of tPA and MT is generally safe for eligible patients with an underlying malignancy. Patients with lung and pancreatic cancers have a higher early risk of recurrent stroke and might need more intensive surveillance and careful institution of the optimal secondary prevention measures.

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Intravenous Thrombolysis in Ischemic Stroke Patients With Active Cancer

Cited by 21 publications

References 16 publications

Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding

Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding

Contemporary utilization patterns and outcomes of thrombolytic administration for ischemic stroke among patients with cancer

In-Hospital Outcomes and Recurrence of Acute Ischemic Stroke in Patients With Solid Organ Malignancy

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