Cancer May Be a Risk Factor for Ischemic Stroke

Stroke alert

By Matthew E. Fink, MD, Professor and Chairman, Department of Neurology, Weill Cornell Medical College, and Neurologist-in-Chief, New York Presbyterian Hospital. Matthew Fink, MD, is a retained consultant for MAQUET.

This article originally appeared in the December 2012 issue of Neurology Alert. It was peer reviewed by M. Flint Beal, MD. Dr. Beal is Anne Parrish Titzel Professor, Department of Neurology and Neuroscience, Weill Cornell Medical Center. Dr. Beal reports no financial relationships relevant to this field of study.

Source: Schwarzbach CJ, et al. Stroke and cancer. The importance of cancer-associated hypercoagulation as a possible stroke etiology. Stroke 2012;43:3029-3034.

A history of cancer in a patient with ischemic stroke often raises additional concerns for the clinician, including assessment of cancer activity, as well as possible thrombophilias. The use of thrombolytic agents is also controversial in patients with active cancers. These investigators in Mannheim, Germany, attempted to assess the role of cancer-associated hypercoagulability as a risk factor for stroke by comparing a group of 140 patients with active cancer (solid tumors, excluding hematological malignancies and brain tumors) and ischemic stroke to a group of age- and sex-matched controls who had ischemic stroke without any cancer history. They collected data prospectively, including laboratory data, MRI, etiology and risk factors for stroke, types of cancer, deep vein thrombosis or pulmonary embolism, and D-dimer levels.

One hundred forty stroke/cancer patients were compared to 140 stroke controls. In the cancer patients with stroke, an unidentified cause for stroke (P < 0.001) and infarction in multiple vascular territories (P < 0.001) were more frequent, and D-dimer levels were significantly higher (P < 0.05) in patients with stroke and cancer. In the noncancer stroke patients, conventional risk factors, such as hypertension (P < 0.05) and hyperlipidemia (P < 0.01), were more common. Deep vein thrombosis and pulmonary embolism were more frequent (P < 0.01) and D-dimer levels were higher (P < 0.01) in cancer-associated stroke compared to controls. Lung and pancreatic cancer were significantly overrepresented and manifested higher D-dimer levels compared to patients with stroke and other types of cancer.

This study supports the concept that there is a hypercoagulable state associated with solid tumor cancers, especially in those who have an elevated D-dimer level, and that cancer may be a risk factor for ischemic stroke. The role of antithrombotic therapies in this group of patients is unknown and needs further investigation.