Key result
Post-treatment plasma D-dimer levels ≥10 µg/ml were independently associated with a 9.61-fold increased odds of poor outcomes at 30 days in patients with cancer-associated stroke.
Why the study?
Hypercoagulability increases risks of ischemic stroke and mortality in active cancer, but the relationship between post-treatment plasma D-dimer levels and short-term outcomes in cancer-associated stroke required investigation.
Are post-treatment plasma D-dimer levels ≥10 μg/ml associated with poor outcomes and mortality at 30 days in patients with cancer-associated stroke?
Observational (n=282)
Yes
Are post-treatment plasma D-dimer levels ≥10 μg/ml associated with poor outcomes and mortality at 30 days in patients with cancer-associated stroke?
High post-treatment plasma D-dimer levels (≥10 μg/ml) are strongly associated with poor short-term outcomes and mortality in patients with cancer-associated stroke, suggesting a potential role for targeted anticoagulation to reduce D-dimer levels.
Answers are grounded in this paper and cite their sources.
May warrant closer monitoring in cancer-associated stroke; hypothesis-generating for D-dimer-targeted anticoagulation trials.
Background and Objective Hypercoagulability is associated with increased risks of ischemic stroke and subsequent mortality in patients with active cancer. This study investigated the relationships between plasma D-dimer levels after stroke treatment and short-term outcomes in patients with cancer-associated stroke. Methods This retrospective, observational, multicenter study analyzed consecutive patients with cancer-associated ischemic stroke. Hypercoagulability was assessed by plasma D-dimer levels before and after stroke treatment. Short-term outcomes were assessed in terms of poor outcomes (a modified Rankin Scale score >3), cumulative rates of recurrent ischemic stroke, and mortality at 30 days after admission. Results Of 282 patients, 135 (47.9%) showed poor outcomes. Recurrent ischemic stroke was observed in 28 patients (9.9%), and the cumulative mortality rate was 12.4%. Multivariate analysis showed that post-treatment plasma D-dimer levels ≥10 μg/ml were independently associated with both poor outcomes (adjusted odds ratio [OR], 9.61; 95% confidence interval [CI], 3.60–25.70; P < 0.001) and mortality (adjusted OR, 9.38; 95% CI, 3.32–26.44; P < 0.001). Pre-treatment plasma D-dimer levels ≥10 μg/ml were not associated with these outcomes. Patients who received heparin had higher pre-treatment plasma D-dimer levels than those treated with other anticoagulants. Heparin produced a significant reduction in D-dimer levels from pre- to post-treatment without increasing the incidence of hemorrhagic events. Conclusion A high plasma D-dimer level after stroke treatment was associated with poor short-term outcomes in patients with cancer-associated stroke. Using anticoagulants to reduce D-dimer levels may improve short-term outcomes in these patients.
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Nakajima et al. (2022) conducted an observational in Cancer-associated ischemic stroke (n=282). Post-treatment plasma D-dimer levels ≥10 µg/ml vs. Post-treatment plasma D-dimer levels <10 µg/ml was evaluated on Poor outcome (mRS score >3) at 30 days (OR 9.61, 95% CI 3.60-25.70, p=<0.001). Post-treatment plasma D-dimer levels ≥10 µg/ml were independently associated with a 9.61-fold increased odds of poor outcomes at 30 days in patients with cancer-associated stroke.
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