Revascularization therapies for acute ischemic stroke (AIS) include intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rtPA) as standard medical treatment, up to 4.5 h from symptom onset and endovascular therapies (EVT), to supplement IVT in selected patients, or in patients who are ineligible to IVT [1, 2]. Symptomatic intracerebral hemorrhage (sICH) is an uncommon but severe complication of IVT (sICH rates 2–7%) [3], so some clinicians are reluctant to use systemic thrombolysis in patients with acute stroke, in particular, if an active malignancy is coexistent, due to safety concerns. Moreover, it has been reported that AIS in patients with active cancer is associated with a worse prognosis than in patients without active cancer [4]. Up to 15% of cancer patients have a concomitant cerebrovascular disease [5]. Ischemic stroke may affect patients with a known cancer diagnosis [6] or may precede the diagnosis of the neoplastic disease [7]. The increased stroke risk seems to be secondary to direct and indirect malignancy effects, including cancer treatment options themselves [4]. A tumorinduced hypercoagulable state favors the onset of ischemic stroke in these patients. The AIS etiology in these patients was reported to be embolic in 54% (in particular cardioembolic in 15%), while non-embolic in 46% of cases (largevessel atherosclerosis 10%; small-vessel occlusion 12%) [7]. In our retrospective study, we assessed and then compared the impact of IVT on AIS patients with and without diagnosed active cancer.
Safety and efficacy of intravenous thrombolysis in patients with acute stroke and active cancer: retrospective cohort study
Paciaroni, MaurizioWriting – Review & Editing
2022
Abstract
Revascularization therapies for acute ischemic stroke (AIS) include intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rtPA) as standard medical treatment, up to 4.5 h from symptom onset and endovascular therapies (EVT), to supplement IVT in selected patients, or in patients who are ineligible to IVT [1, 2]. Symptomatic intracerebral hemorrhage (sICH) is an uncommon but severe complication of IVT (sICH rates 2–7%) [3], so some clinicians are reluctant to use systemic thrombolysis in patients with acute stroke, in particular, if an active malignancy is coexistent, due to safety concerns. Moreover, it has been reported that AIS in patients with active cancer is associated with a worse prognosis than in patients without active cancer [4]. Up to 15% of cancer patients have a concomitant cerebrovascular disease [5]. Ischemic stroke may affect patients with a known cancer diagnosis [6] or may precede the diagnosis of the neoplastic disease [7]. The increased stroke risk seems to be secondary to direct and indirect malignancy effects, including cancer treatment options themselves [4]. A tumorinduced hypercoagulable state favors the onset of ischemic stroke in these patients. The AIS etiology in these patients was reported to be embolic in 54% (in particular cardioembolic in 15%), while non-embolic in 46% of cases (largevessel atherosclerosis 10%; small-vessel occlusion 12%) [7]. In our retrospective study, we assessed and then compared the impact of IVT on AIS patients with and without diagnosed active cancer.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
