Santosh B Murthy1, Siddharth Karanth, Shreyansh Shah, Aditi Shastri, Chethan P Venkatasubba Rao, Eric M Bershad, Jose I Suarez. 1. From the Department of Neurology, Baylor College of Medicine, Houston, TX (S.B.M., S.S., C.P.V.R., E.M.B., J.I.S.); Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX (S.K.); and Department of Hematology and Oncology, Montefiore Medical Center, Bronx, NY (A.S.).
Abstract
BACKGROUND AND PURPOSE: The safety of thrombolysis for acute stroke in patients with cancer is not well established. Our aim is to study the outcomes after thrombolysis in patients with stroke with cancer. METHODS: Patients with acute ischemic stroke who received thrombolysis were identified from the 2009 and 2010 Nationwide Inpatient Sample. Patients with cancer-associated strokes and noncancer strokes were compared based on demographics, comorbidities, and outcomes. RESULTS: Of the 32 576 strokes treated with thrombolysis, cancer-associated strokes had significantly higher comorbidity indices overall, but fewer vascular risk factors than noncancer strokes. There was no difference in the rates of home discharge and in-hospital mortality, after adjusting for confounders. Subgroup analysis showed that compared with liquid cancers, patients with solid tumors had worse home discharge (odds ratio, 0.178; 95% confidence interval, 0.109-0.290; P<0.001) and higher in-hospital mortality (odds ratio, 3.018; 95% confidence interval, 1.37-6.646; P=0.006) after thrombolysis. Metastatic cancers had poorest outcomes, but intracerebral hemorrhage rates were similar. CONCLUSIONS: Thrombolytic therapy for acute stroke in patients with cancer is not associated with increased risk of intracerebral hemorrhage or in-hospital mortality. However, careful consideration of the cancer subtype may help delineate the subset of patients with poor response to thrombolysis. Prospective confirmation is warranted.
BACKGROUND AND PURPOSE: The safety of thrombolysis for acute stroke in patients with cancer is not well established. Our aim is to study the outcomes after thrombolysis in patients with stroke with cancer. METHODS:Patients with acute ischemic stroke who received thrombolysis were identified from the 2009 and 2010 Nationwide Inpatient Sample. Patients with cancer-associated strokes and noncancer strokes were compared based on demographics, comorbidities, and outcomes. RESULTS: Of the 32 576 strokes treated with thrombolysis, cancer-associated strokes had significantly higher comorbidity indices overall, but fewer vascular risk factors than noncancer strokes. There was no difference in the rates of home discharge and in-hospital mortality, after adjusting for confounders. Subgroup analysis showed that compared with liquid cancers, patients with solid tumors had worse home discharge (odds ratio, 0.178; 95% confidence interval, 0.109-0.290; P<0.001) and higher in-hospital mortality (odds ratio, 3.018; 95% confidence interval, 1.37-6.646; P=0.006) after thrombolysis. Metastatic cancers had poorest outcomes, but intracerebral hemorrhage rates were similar. CONCLUSIONS: Thrombolytic therapy for acute stroke in patients with cancer is not associated with increased risk of intracerebral hemorrhage or in-hospital mortality. However, careful consideration of the cancer subtype may help delineate the subset of patients with poor response to thrombolysis. Prospective confirmation is warranted.
Authors: Santosh B Murthy; Aditi Shastri; Alexander E Merkler; Daniel F Hanley; Wendy C Ziai; Matthew E Fink; Costantino Iadecola; Hooman Kamel; Babak B Navi Journal: J Stroke Cerebrovasc Dis Date: 2016-08-25 Impact factor: 2.136
Authors: Joerg Herrmann; Eric H Yang; Cezar A Iliescu; Mehmet Cilingiroglu; Konstantinos Charitakis; Abdul Hakeem; Konstantinos Toutouzas; Massoud A Leesar; Cindy L Grines; Konstantinos Marmagkiolis Journal: Circulation Date: 2016-03-29 Impact factor: 29.690