Thrombolysis for Acute Ischemic Stroke in Patients With Cancer

Abstract

Background and Purpose— The safety of thrombolysis for acute stroke in patients with cancer is not well established. Our aim is to study the outcomes after thrombolysis in patients with stroke with cancer. Methods— Patients with acute ischemic stroke who received thrombolysis were identified from the 2009 and 2010 Nationwide Inpatient Sample. Patients with cancer-associated strokes and noncancer strokes were compared based on demographics, comorbidities, and outcomes. Results— Of the 32 576 strokes treated with thrombolysis, cancer-associated strokes had significantly higher comorbidity indices overall, but fewer vascular risk factors than noncancer strokes. There was no difference in the rates of home discharge and in-hospital mortality, after adjusting for confounders. Subgroup analysis showed that compared with liquid cancers, patients with solid tumors had worse home discharge (odds ratio, 0.178; 95% confidence interval, 0.109–0.290; P <0.001) and higher in-hospital mortality (odds ratio, 3.018; 95% confidence interval, 1.37–6.646; P =0.006) after thrombolysis. Metastatic cancers had poorest outcomes, but intracerebral hemorrhage rates were similar. Conclusions— Thrombolytic therapy for acute stroke in patients with cancer is not associated with increased risk of intracerebral hemorrhage or in-hospital mortality. However, careful consideration of the cancer subtype may help delineate the subset of patients with poor response to thrombolysis. Prospective confirmation is warranted.

The Activity of Malignancy May Determine Stroke Pattern in Cancer Patients

“…Oberndorfer et al 12 suggested that cancer may increase the risk of hemorrhagic complications. However, our experience together with recent observations of Murthy et al 24 show that alteplase can be used safely and successfully in this group of patients, irrespective of the type of cancer.…”

Intracerebral Hemorrhage Outcomes in Patients with Systemic Cancer

“…Patients with cancer were divided into three categories based on the National Comprehensive Cancer Network classification: solid tumors without metastases (ICD-9-CM 140.xx- 190.xx, 193.xx-195.xx, 209.00–209.30), hematologic tumors without metastases (200.xx-208.xx, 238.7x), and metastatic solid or hematologic tumors (196.xx-198.xx, 209.7x). (12) The ICD-9 codes for individual cancers have been used in prior NIS studies(13, 14), and can be obtained using the Clinical Classification Software provided by the Healthcare Cost and Utilization Project. (15)…”

In-hospital outcomes of thrombolysis for acute ischemic stroke in patients with primary brain tumors

“…Patients with systemic malignancies and brain tumors are generally perceived to have a higher risk of intracerebral hemorrhage (ICH) and worse outcomes, and are therefore usually excluded from intravenous thrombolysis. Recent retrospective observational studies have suggested that thrombolysis outcomes may be favorable in patients with systemic malignancies, with no difference in ICH rates among liquid, solid or metastatic tumors [7,8]. On the other hand, literature on outcome of stroke thrombolysis in patients with brain tumors is limited to case reports with possible publication bias for favorable outcomes [9].…”