Direct oral anticoagulants may be a potentially useful choice for secondary prevention of cancer-associated stroke, though their application remains controversial due to limited evidence.
Do direct oral anticoagulants prevent thromboembolic events better than warfarin in patients with cancer-associated ischemic stroke?
This review suggests that direct oral anticoagulants may be preferable to warfarin for preventing thromboembolic events in patients with cancer-associated ischemic stroke due to their ability to block the coagulation cascade.
Patients with cancer-associated ischemic stroke pose similar clinical manifestations and image characteristics, mainly embolic infarction, as patients with atrial fibrillation do. D-dimer, a degraded product of fibrin polymer, is a useful indicator of hypercoagulability, which frequently increases in cancer-associated stroke, but not in stroke resulted from atrial fibrillation. The level of serum D-dimer is associated with mortality, prognosis, and recurrence of systemic thromboembolism in these patients. Theoretically, drugs block coagulation cascade, such as heparin and low-molecular-weight-heparin (LMWH), oral direct anticoagulants, could attenuate the status of hypercoagulation and decrease the amount of D-dimer. These drugs may be helpful to prevent thromboembolic events in patients with cancer-associated hypercoagulability. Vitamin K antagonist, warfarin, decreases the production of coagulation factors, but not interrupts coagulation cascade may not be helpful to decrease hypercoagulability, but increase the risk of bleeding. However, the treatment of cancer-associated embolic stroke is still controversial. This article reviews relevant clinical studies and proposes the applicability of direct oral anticoagulants from the pathophysiological mechanism.
Liu et al. (Tue,) conducted a review in Cancer-associated ischemic stroke. Anticoagulants (Direct oral anticoagulants, LMWH, Warfarin) was evaluated. Direct oral anticoagulants may be a potentially useful choice for secondary prevention of cancer-associated stroke, though their application remains controversial due to limited evidence.