Key result
In cancer patients with acute ischemic stroke, D-dimer levels >1.11 microg/dL were independently associated with cryptogenic stroke mechanisms (OR 10.6; 95% CI 3.29-33.8).
Why the study?
Are diffusion-weighted imaging lesion patterns and D-dimer levels associated with cryptogenic stroke mechanisms in cancer patients with acute ischemic stroke?
Observational (n=161)
Yes
Are diffusion-weighted imaging lesion patterns and D-dimer levels associated with cryptogenic stroke mechanisms in cancer patients with acute ischemic stroke?
Odds Ratio: 10.6 (95% CI 3.29–33.8)
In cancer patients with acute ischemic stroke, multiple vascular territory lesions on DWI and elevated D-dimer levels are strongly associated with cryptogenic stroke mechanisms, suggesting cancer-associated coagulopathy.
D-dimer and DWI patterns may distinguish mechanisms in cancer-associated stroke; leaves open optimal antithrombotic strategies.
BACKGROUND AND METHODS: To assess the precise mechanisms of stroke in cancer patients, we analyzed the data for cancer patients with acute ischemic stroke registered from 6 centers in South Korea. Clinical features, risk factors, diffusion-weighted imaging lesion patterns, and laboratory findings including D-dimer levels were compared between patients with conventional stroke mechanisms (CSMs) and cryptogenic group. RESULTS: A total of 161 patients were included in this study: 97 (60.2%) patients in the CSM group and 64 (39.8%) in the cryptogenic group. Patients in the CSM group were older and vascular risk factors were more prevalent than in the cryptogenic group. Diffusion-weighted imaging patterns of multiple lesions involving multiple arterial territories were observed more frequently in the cryptogenic group than in the CSM group. In addition, levels of the D-dimer were higher in the cryptogenic group than in the CSM group (11.5+/-14.6 versus 3.6+/-10.3 microg/dL). In multivariate analysis, the diffusion-weighted imaging lesion pattern of multiple vascular territories (odds ratio, 11.2; 95% CI, 3.74 to 33.3), and D-dimer levels of >1.11 microg/dL (odds ratio, 10.6; 95% CI, 3.29 to 33.8) were associated independently with the cryptogenic group. CONCLUSIONS: Stroke outside of CSM occurred in a large number in cancer patients. In stroke patients with cancer, d-dimer levels and diffusion-weighted imaging lesion patterns may be helpful in early identification of non-CSMs (especially coagulopathy associated with cancer) and possibly in guiding preventive strategies for stroke.
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Kim et al. (2010) conducted an observational in Acute ischemic stroke in cancer patients (n=161). D-dimer levels >1.11 microg/dL vs. Lower D-dimer levels was evaluated on Cryptogenic stroke mechanism (OR 10.6, 95% CI 3.29-33.8). In cancer patients with acute ischemic stroke, D-dimer levels >1.11 microg/dL were independently associated with cryptogenic stroke mechanisms (OR 10.6; 95% CI 3.29-33.8).
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