Hsu Jin-Yi, Liu An-Bang
Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2019 Jul-Sep;31(3):144-148. doi: 10.4103/tcmj.tcmj_55_19.
Patients with cancer-associated ischemic stroke pose similar clinical manifestations and image characteristics, mainly embolic infarction, as patients with atrial fibrillation do. D-dimer, a degraded product of fibrin polymer, is a useful indicator of hypercoagulability, which frequently increases in cancer-associated stroke, but not in stroke resulted from atrial fibrillation. The level of serum D-dimer is associated with mortality, prognosis, and recurrence of systemic thromboembolism in these patients. Theoretically, drugs block coagulation cascade, such as heparin and low-molecular-weight-heparin (LMWH), oral direct anticoagulants, could attenuate the status of hypercoagulation and decrease the amount of D-dimer. These drugs may be helpful to prevent thromboembolic events in patients with cancer-associated hypercoagulability. Vitamin K antagonist, warfarin, decreases the production of coagulation factors, but not interrupts coagulation cascade may not be helpful to decrease hypercoagulability, but increase the risk of bleeding. However, the treatment of cancer-associated embolic stroke is still controversial. This article reviews relevant clinical studies and proposes the applicability of direct oral anticoagulants from the pathophysiological mechanism.
与癌症相关的缺血性中风患者与房颤患者具有相似的临床表现和影像特征，主要为栓塞性梗死。D-二聚体是纤维蛋白聚合物的降解产物，是高凝状态的有用指标，在与癌症相关的中风中常升高，但在房颤所致中风中则不然。血清D-二聚体水平与这些患者的死亡率、预后及系统性血栓栓塞复发有关。理论上，阻断凝血级联反应的药物，如肝素和低分子肝素（LMWH）、口服直接抗凝剂，可减轻高凝状态并降低D-二聚体水平。这些药物可能有助于预防与癌症相关的高凝状态患者发生血栓栓塞事件。维生素K拮抗剂华法林可减少凝血因子的产生，但不阻断凝血级联反应，可能无助于降低高凝状态，反而会增加出血风险。然而，癌症相关栓塞性中风的治疗仍存在争议。本文回顾了相关临床研究，并从病理生理机制角度提出了直接口服抗凝剂的适用性。
