Recurrent thromboembolic events after ischemic stroke in patients with cancer.
OBJECTIVE
To determine the cumulative rate and characteristics of recurrent thromboembolic events after acute ischemic stroke in patients with cancer.


METHODS
We retrospectively identified consecutive adult patients with active systemic cancer diagnosed with acute ischemic stroke at a tertiary-care cancer center from 2005 through 2009. Two neurologists independently reviewed all electronic records to ascertain the composite outcome of recurrent ischemic stroke, myocardial infarction, systemic embolism, TIA, or venous thromboembolism. Kaplan-Meier statistics were used to determine cumulative outcome rates. In exploratory analyses, Cox proportional hazard analysis was used to evaluate potential independent associations between a priori selected clinical factors and recurrent thromboembolic events.


RESULTS
Among 263 study patients, complete follow-up until death was available in 230 (87%). Most patients had an adenocarcinoma as their underlying cancer (60%) and had systemic metastases (69%). Despite a median survival of 84 days (interquartile range 24-419 days), 90 patients (34%; 95% confidence interval 28%-40%) had 117 recurrent thromboembolic events, consisting of 57 cases of venous thromboembolism, 36 recurrent ischemic strokes, 13 myocardial infarctions, 10 cases of systemic embolism, and one TIA. Kaplan-Meier rates of recurrent thromboembolism were 21%, 31%, and 37% at 1, 3, and 6 months, respectively; cumulative rates of recurrent ischemic stroke were 7%, 13%, and 16%. Adenocarcinoma histology (hazard ratio 1.65, 95% confidence interval 1.02-2.68) was independently associated with recurrent thromboembolism.


CONCLUSIONS
Patients with acute ischemic stroke in the setting of active cancer (especially adenocarcinoma) face a substantial short-term risk of recurrent ischemic stroke and other types of thromboembolism.
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY. ban9003@med.cornell.edu.
Babak B
BB
Navi
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
Samuel
S
Singer
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
Alexander E
AE
Merkler
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
Natalie T
NT
Cheng
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
Jacqueline B
JB
Stone
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
Hooman
H
Kamel
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
Costantino
C
Iadecola
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
Mitchell S V
MS
Elkind
From the Department of Neurology and the Brain and Mind Research Institute (B.B.N., A.E.M., N.T.C., J.B.S., H.K., C.I., L.M.D.), Weill Cornell Medical College, New York; Department of Neurology (B.B.N., S.S., L.M.D.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (M.S.V.E.), Columbia University, New York, NY.
Lisa M
LM
DeAngelis
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology / Q000503:physiopathology*; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000453:epidemiology*; D013923:Thromboembolism / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult