Babak B Navi1, Samuel Singer2, Alexander E Merkler2, Natalie T Cheng2, Jacqueline B Stone2, Hooman Kamel2, Costantino Iadecola2, Mitchell S V Elkind2, Lisa M DeAngelis2. 1. 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. 2. 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.
Abstract
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.
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.
Authors: Christopher J Schwarzbach; Anke Schaefer; Anne Ebert; Valentin Held; Manuel Bolognese; Micha Kablau; Michael G Hennerici; Marc Fatar Journal: Stroke Date: 2012-09-20 Impact factor: 7.914
Authors: Agnes Y Y Lee; Mark N Levine; Ross I Baker; Chris Bowden; Ajay K Kakkar; Martin Prins; Frederick R Rickles; Jim A Julian; Susan Haley; Michael J Kovacs; Michael Gent Journal: N Engl J Med Date: 2003-07-10 Impact factor: 91.245
Authors: Alexander E Merkler; Babak B Navi; Samuel Singer; Natalie T Cheng; Jacqueline B Stone; Hooman Kamel; Costantino Iadecola; Mitchell S V Elkind; Lisa M DeAngelis Journal: J Neurooncol Date: 2015-04-08 Impact factor: 4.130
Authors: Babak B Navi; Anne S Reiner; Hooman Kamel; Costantino Iadecola; Peter M Okin; Mitchell S V Elkind; Katherine S Panageas; Lisa M DeAngelis Journal: J Am Coll Cardiol Date: 2017-08-22 Impact factor: 24.094
Authors: Babak B Navi; Randolph S Marshall; Dylan Bobrow; Samuel Singer; Jacqueline B Stone; Maria T DeSancho; Lisa M DeAngelis Journal: JAMA Neurol Date: 2018-03-01 Impact factor: 18.302
Authors: Yong-Won Shin; Soon-Tae Lee; Keun-Hwa Jung; Do-Yong Kim; Chul-Kee Park; Tae Min Kim; Seung Hong Choi; Kon Chu; Sang Kun Lee Journal: J Neurooncol Date: 2016-03-11 Impact factor: 4.130
Authors: Adam de Havenon; Anne Moore; Ali Sultan-Qurraie; Jennifer J Majersik; Greg Stoddard; David Tirschwell Journal: Transl Stroke Res Date: 2015-07-25 Impact factor: 6.829
Authors: Hebun Erdur; Lennart S Milles; Jan F Scheitz; Kersten Villringer; Karl Georg Haeusler; Matthias Endres; Heinrich J Audebert; Jochen B Fiebach; Christian H Nolte Journal: Eur Radiol Date: 2018-08-23 Impact factor: 5.315
Authors: Santosh B Murthy; Mary Cushman; Dylan Bobrow; Hooman Kamel; Alexander E Merkler; Mitchell S V Elkind; Lisa M DeAngelis; Babak B Navi Journal: J Clin Neurosci Date: 2018-08-23 Impact factor: 1.961
Authors: Babak B Navi; Samuel Singer; Alexander E Merkler; Natalie T Cheng; Jacqueline B Stone; Hooman Kamel; Costantino Iadecola; Mitchell S V Elkind; Lisa M DeAngelis Journal: Stroke Date: 2014-07-03 Impact factor: 7.914