What is the clinical evidence from this study?

Study design: Observational. Population: Ischemic stroke or transient ischemic attack (n=4727). Intervention: Active cancer vs. Non-cancer. Primary outcome: Recurrent ischemic stroke (HR 1.20, 95% CI 0.45-3.24).

What does this research mean for the field?

Patients with ischemic stroke or transient ischemic attack and active cancer had a significantly higher 1-year mortality rate of 7.7% compared to 2.1% in non-cancer patients (HR 5.61). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The study aims to assess the impacts of oral antithrombotic therapy on recurrent ischemic stroke, major bleeding, and mortality among patients with ischemic stroke and active cancer.

February 2, 2026

Abstract DP299: Oral antithrombotic therapy for patients with stroke and active cancer: A secondary analysis of BAT 2 study

Key Result

Active cancer in patients with ischemic stroke or TIA was associated with higher 1-year mortality compared to non-cancer patients (7.7% vs 2.1%, HR 5.61; 95% CI 3.41-9.24), but not recurrent stroke.

Key Points

The study aims to assess the impacts of oral antithrombotic therapy on recurrent ischemic stroke, major bleeding, and mortality among patients with ischemic stroke and active cancer.
Analyzed patients enrolled in a multicenter observational study from 2016 to 2019.
Collected data on patients with ischemic stroke or transient ischemic attack receiving oral antithrombotic therapy.
Grouped patients with active cancer and non-cancer for comparative analysis.
1-year mortality rate was higher in the active cancer group (7.7%) compared to non-cancer (2.1%).
No significant differences in recurrent ischemic stroke or major bleeding rates between the two groups.
Type of oral antithrombotic agent did not affect mortality rates.

Study Design

Type

Observational (n=4,727)

Multicenter

Yes

Structured PICO

Does active cancer increase the risk of recurrent ischemic stroke, major bleeding, or mortality in patients with IS/TIA receiving oral antithrombotic therapy?

Population

4,727 patients with ischemic stroke (IS) or transient ischemic attack (TIA) receiving oral antithrombotic therapy for secondary stroke prevention, median age 72, 33.0% women. 91 (1.9%) had active cancer.

Intervention

Active cancer (uncured cancer)

Comparator

Non-cancer (patients without active cancer)

Outcome

1-year rates of recurrent ischemic stroke, major bleeding, and all-cause mortalityhard clinical

In patients with IS/TIA on antithrombotic therapy, active cancer is associated with significantly higher 1-year mortality but not increased recurrent stroke or major bleeding, regardless of the type of antithrombotic agent used.

Main Result

Effect estimate: HR 1.20 (95% CI 0.45-3.24)

Absolute Event Rate: 3.4% vs 2.5%

Abstract

Introduction: Patients with ischemic stroke (IS) or transient ischemic attack (TIA) who also have cancer are at risks for ischemic and bleeding events, and mortality. The optimal oral antithrombotic therapy for secondary stroke prevention in patients with cancer remains unclear. This study aimed to reveal the differences in recurrent IS, major bleeding (MB), and all-cause mortality in patients with IS/TIA who had with cancer. Methods: In this investigator-initiated, prospective, multicenter, observational study, patients with cerebrovascular or cardiovascular diseases, who were taking oral antiplatelet and/or anticoagulant agents, were enrolled from October 2016 to April 2019. For this secondary analysis, we collected data on patients with IS/TIA receiving oral antithrombotic therapy for secondary stroke prevention. Patients with uncured cancer was defined as active cancer (AC) and others as non-cancer groups. Results: Of the 4,727 patients (median age: 72 IQR: 65–79 years; 1,561 33.0% women) with IS/TIA, 91 (1.9%) had AC. Of all patients, 3,354 were treated with antiplatelet agent 65, 1.9% with cancer, 1,134 patients to anticoagulant agent 17, 1.5%, and 239 patients to combination therapy 9, 3.8%. The 1-year rates of recurrent IS (3.4% vs. 2.5%, HR 1.20, 95%CI 0.45-3.24) and MB (0% vs. 1.1%, HR 1.32, 95%CI 0.33-5.39) were not significantly different between AC and non-cancer groups. However, the 1-year mortality rate was significantly higher in the AC than non-cancer group (7.7% vs. 2.1%, HR 5.61, 95%CI 3.41-9.24). In the AC group (median age: 78 IQR: 70–83 years; 26 28.6% women; 65 patients to antiplatelet; 17 anticoagulant; 9 combination], the 1-year rates of recurrent IS (3.2%, 5.9%, 0%), MB (3.2%, 5.9%, 0%) and mortality (4.6%, 17.6%, 11.1%) were not significantly different between antiplatelet, anticoagulant, and combination therapy, respectively. The multivariable Cox regression analysis revealed that female (aHR 0.13, 95%CI 0.02-0.76), dyslipidemia (aHR 0.19, 95%CI 0.04-0.83), CRP (aHR 1.45, 95%CI 1.16-1.80) and D-dimer (aHR 1.17, 95%CI 1.05-1.31) were independent predictor of mortality. Conclusion: Patients with IS/TIA and AC had a higher risk of mortality than those without cancer. The type of oral antithrombotic agent was not associated with recurrent IS, MB or mortality.