J Stroke.  2017 Jan;19(1):77-87. 10.5853/jos.2016.00570.

Hypercoagulability and Mortality of Patients with Stroke and Active Cancer: The OASIS-CANCER Study

• Lee MJ
• Chung JW
• Ahn MJ
• Kim S
• Seok JM
• Jang HM
• Kim GM
• Chung CS
• Lee KH
• Bang OY

• KMID: 2368404
• DOI: http://doi.org/10.5853/jos.2016.00570

Abstract

BACKGROUND AND PURPOSE
Patients with active cancer are at an increased risk for stroke. Hypercoagulability plays an important role in cancer-related stroke. We aimed to test whether 1) hypercoagulability is a predictor of survival, and 2) correction of the hypercoagulable state leads to better survival in patients with stroke and active cancer.
METHODS
We recruited consecutive patients with acute ischemic stroke and active systemic cancer between January 2006 and July 2015. Hypercoagulability was assessed using plasma D-dimer levels before and after 7 days of anticoagulation treatment. The study outcomes included overall and 1-year survival. Plasma D-dimer levels before and after treatment were tested in univariate and multivariate Cox regression models. We controlled for systemic metastasis, stroke mechanism, age, stroke severity, primary cancer type, histology, and atrial fibrillation using the forward stepwise method.
RESULTS
A total of 268 patients were included in the analysis. Patients with high (3rd-4th quartiles) pre-treatment plasma D-dimer levels showed decreased overall and 1-year survival (adjusted HR, 2.19 [95% CI, 1.46-3.31] and 2.70 [1.68-4.35], respectively). After anticoagulation treatment, post-treatment D-dimer level was significantly reduced and independently associated with poor 1-year survival (adjusted HR, 1.03 [95% CI, 1.01-1.05] per 1 μg/mL increase, P=0.015). The successful correction of hypercoagulability was a protective factor for 1-year survival (adjusted HR 0.26 [CI 0.10-0.68], P=0.006).
CONCLUSIONS
Hypercoagulability is associated with poor survival after stroke in patients with active cancer. Effective correction of hypercoagulability may play a protective role for survival in these patients.

Keyword

Ischemic stroke; cancer; hypercoagulability; survival; prognosis

MeSH Terms

Atrial Fibrillation
Humans
Methods
Mortality*
Neoplasm Metastasis
Plasma
Prognosis
Protective Factors
Stroke*
Thrombophilia*