Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Stroke. 2012 Nov;43(11):3029-34. doi: 10.1161/STROKEAHA.112.658625. Epub 2012 Sep 20.
The importance of cancer-associated hypercoagulability as a possible stroke etiology in patients with cancer has received relatively little attention to date. A recent study has suggested that cancer-associated hypercoagulation may be of special importance in the absence of conventional stroke mechanisms.
We identified patients with ischemic stroke sequentially admitted to our stroke center with the additional diagnosis of active and malignant cancer from 2002 to 2011. By using our prospectively collected stroke, MRI, and laboratory data banks, the etiology and risk factors of stroke, types of cancer, deep vein thrombosis/pulmonary embolism, d-dimer levels, and diffusion-weighted imaging lesion patterns were compared to an age- and sex-matched control group. Patients with cancer with a conventional stroke etiology and patients with an unidentified and/or cancer-associated stroke etiology were analyzed separately.
One hundred forty patients with cancer and 140 control subjects were included. Unidentified stroke (P<0.001) and infarction in multiple vascular territories (P<0.001) were significantly more frequent and d-dimer levels significantly higher (P<0.05) in patients with cancer. Vice versa, risk factors such as hypertension (P<0.05) and hyperlipidemia (P<0.01) were more prevalent in control subjects. Deep vein thrombosis and pulmonary embolism were more frequent (P<0.01) and d-dimer levels higher (P<0.01) in the patients with unidentified and/or cancer-associated stroke etiology compared to the patients with cancer with a conventional stroke etiology. Lung and pancreatic cancer were significantly overrepresented and d-dimer levels higher in these patients compared with other patients with cancer (P<0.01).
Our data confirm the concept of cancer-associated hypercoagulation as a widely underestimated important stroke risk factor in patients with cancer, especially in those with severely elevated d-dimer levels and in the absence of conventional risk factors.
癌症相关高凝状态作为癌症患者发生中风的可能病因，目前尚未得到充分重视。最近的一项研究表明，在没有常规中风机制的情况下，癌症相关的高凝状态可能具有特殊重要性。
我们从 2002 年至 2011 年连续纳入我院卒中中心诊断为活动期恶性肿瘤合并缺血性卒中的患者。通过使用我们前瞻性收集的卒中、MRI 和实验室数据库，比较了卒中的病因和危险因素、癌症类型、深静脉血栓形成/肺栓塞、D-二聚体水平和弥散加权成像病灶模式，与年龄和性别匹配的对照组。我们分别分析了有明确中风病因的癌症患者和病因不明或与癌症相关的中风患者。
共纳入 140 例癌症患者和 140 例对照组。癌症患者中不明原因的中风（P<0.001）和多个血管区域的梗死（P<0.001）更为常见，D-二聚体水平明显升高（P<0.05）。相反，高血压（P<0.05）和高血脂（P<0.01）等危险因素在对照组中更为常见。与有明确中风病因的癌症患者相比，不明原因或与癌症相关的中风患者深静脉血栓形成和肺栓塞更为常见（P<0.01），D-二聚体水平更高（P<0.01）。与其他癌症患者相比，这些患者中肺癌和胰腺癌的比例明显更高，D-二聚体水平也更高（P<0.01）。
我们的数据证实了癌症相关高凝状态是癌症患者中一个被广泛低估的重要中风危险因素的概念，尤其是在 D-二聚体水平显著升高且无常规危险因素的情况下。
