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.
Observational (n=4,727)
Yes
Does active cancer increase the risk of recurrent ischemic stroke, major bleeding, or mortality in patients with IS/TIA receiving oral antithrombotic therapy?
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.
Effect estimate: HR 1.20 (95% CI 0.45-3.24)
Absolute Event Rate: 3.4% vs 2.5%
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.
Kawano et al. (2026) conducted an observational in Ischemic stroke or transient ischemic attack (n=4,727). Active cancer vs. Non-cancer was evaluated on Recurrent ischemic stroke (HR 1.20, 95% CI 0.45-3.24). 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.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: