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.).
Stroke. 2013 Dec;44(12):3573-6. doi: 10.1161/STROKEAHA.113.003058. Epub 2013 Sep 24.
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.
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.
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.
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.
溶栓治疗癌症患者急性卒中的安全性尚未得到充分证实。我们旨在研究伴有癌症的卒中患者溶栓后的结局。
从 2009 年和 2010 年全国住院患者样本中确定接受溶栓治疗的急性缺血性卒中患者。根据人口统计学、合并症和结局比较伴有癌症相关卒中与非癌症相关卒中的患者。
在接受溶栓治疗的 32576 例卒中患者中，癌症相关卒中的总体合并症指数显著较高，但血管危险因素较非癌症相关卒中少。在校正混杂因素后，两组患者的家庭出院率和住院死亡率无差异。亚组分析显示，与液体癌相比，实体瘤患者家庭出院率更差（比值比，0.178；95%置信区间，0.109-0.290；P<0.001），溶栓后住院死亡率更高（比值比，3.018；95%置信区间，1.37-6.646；P=0.006）。转移性癌症的结局最差，但脑出血发生率相似。
溶栓治疗癌症患者急性卒中并不增加脑出血或住院死亡率的风险。然而，仔细考虑癌症亚型可能有助于确定溶栓反应差的患者亚组。需要前瞻性确认。
