Prevalence and Impact of Venous and Arterial Thromboembolism in Patients With Embolic Stroke of Undetermined Source With or Without Active Canceropen access
- Authors
- Ha, J.[Ha, J.]; Lee, M.J.[Lee, M.J.]; Kim, S.J.[Kim, S.J.]; Park, B.-Y.[Park, B.-Y.]; Park, H.[Park, H.]; Cho, S.[Cho, S.]; Chung, J.-W.[Chung, J.-W.]; Seo, W.-K.[Seo, W.-K.]; Kim, G.-M.[Kim, G.-M.]; Bang, O.Y.[Bang, O.Y.]; Chung, C.-S.[Chung, C.-S.]
- Issue Date
- 5-Nov-2019
- Publisher
- NLM (Medline)
- Keywords
- cancer and stroke; deep vein thrombosis; microembolic signal; thromboembolism
- Citation
- Journal of the American Heart Association, v.8, no.21, pp.e013215
- Indexed
- SCIE
SCOPUS
- Journal Title
- Journal of the American Heart Association
- Volume
- 8
- Number
- 21
- Start Page
- e013215
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/14004
- DOI
- 10.1161/JAHA.119.013215
- ISSN
- 2047-9980
- Abstract
- Background An increased risk of acute ischemic stroke is recognized among patients with cancer. However, the mechanism behind cancer-related stroke is unclear. In this study, we determined the presence of associated venous thromboembolism and arterial thromboembolism and their clinical impact on patients with cancer-related stroke. Methods and Results Patients with embolic stroke of undetermined source with or without cancer were evaluated for venous thromboembolism (deep vein thrombosis [DVT] and/or pulmonary embolism) and arterial thromboembolism by using Doppler sonography to determine the presence of lower-extremity DVT and the microembolic signal of the symptomatic cerebral circulation, respectively. Infarct volume was determined by diffusion-weighted magnetic resonance imaging. The multivariable linear regression and Cox proportional hazard analysis were used to investigate the effect of DVT and microembolic signal on infarct volume and 1-year survival, respectively. Of 142 screened patients, 118 were included (37 with, 81 without cancer). Those with cancer had a higher prevalence of DVT or microembolic signal than did the noncancer group (62.2% versus 19.8%; P<0.001). Among patients with cancer-related stroke, DVT was associated with a greater infarct volume in magnetic resonance imaging (beta, 13.14; 95% CI, 1.62-24.66; P=0.028). Presence of DVT (hazard ratio, 16.79; 95% CI, 2.05-137.75; P=0.009) and microembolic signal (hazard ratio, 8.16; 95% CI, 1.36-48.85; P=0.022) were independent predictors of poor 1-year survival. Conclusions Patients with cancer-associated embolic stroke of undetermined source have an elevated risk of associated venous thromboembolism and arterial thromboembolism, both of which have a significant negative impact on 1-year survival. The results of this study may enhance our understanding of cancer-associated stroke and improve risk stratification of patients with this disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov/.Unique identifier: NCT02212496.
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