Key result
Enoxaparin lowers D-dimer in cancer-related stroke, whereas factor Xa inhibitors fail to reduce it.
Why the study?
The optimal strategy for stroke prevention in cancer patients is unknown, and the mechanisms of coagulopathy and effects of anticoagulants in cancer stroke versus AF stroke require clarification.
Observational (n=155)
No
May favor enoxaparin for D-dimer reduction in cancer stroke; hypothesis-generating and should not change practice without RCTs.
Background: The optimal strategy for stroke prevention in cancer patients is unknown. We compared the underlying mechanisms of coagulopathy and the effects of anticoagulants in patients with active cancer and atrial fibrillation (AF). Methods: We retrospectively enrolled 46 consecutive patients with embolic stroke of unknown source and active cancer (cancer stroke). We consecutively screened patients with cancer patients without stroke (n = 29), AF stroke (n = 52), and healthy subjects (n = 28), which served as controls. Patients with cancer stroke were treated with either enoxaparin (a low-molecular-weight heparin) or a factor Xa inhibitor, and those with AF stroke were treated with factor Xa inhibitors. D-dimer, factor Xa, and circulating cell-free DNA (cfDNA), a marker of neutrophil extracellular traposis, were measured at both before and after anticoagulation. Results: In AF stroke, factor Xa activity and cfDNA and D-dimer levels were decreased by treatment with factor Xa inhibitors. In contrast, in cancer stroke, factor Xa activity was decreased, D-dimer levels were unchanged, and cfDNA levels were increased by treatment with factor Xa inhibitors. In cancer stroke patients treated with enoxaparin, D-dimer levels were decreased (p = 0.011) and cfDNA levels were unchanged. Conclusion: The anticoagulation effects of factor Xa inhibitors differed between cancer stroke and AF stroke.
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Kim et al. (2021) conducted an observational in Cancer-related stroke and atrial fibrillation-related stroke (n=155). Factor Xa inhibitors (edoxaban) or low-molecular-weight heparin (enoxaparin) vs. Pre-treatment baseline / Alternate anticoagulant was evaluated on Change in D-dimer, factor Xa, and circulating cell-free DNA (cfDNA) levels after anticoagulation (p=0.011). In cancer-related stroke, factor Xa inhibitors reduced factor Xa activity but did not decrease D-dimer levels and increased cfDNA, whereas enoxaparin significantly decreased D-dimer levels.
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