Cicilioni Kurt, Cristiano Brian, Jacobson J Paul, Hoss Daniel, Lund Matthew, Cheung Shauna, Dye Justin
Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Division of Interventional Neuroradiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Brain Sci. 2020 Aug 26;10(9):590. doi: 10.3390/brainsci10090590.
Since Trousseau's initial publication, the development of thromboembolic events related to malignancy has been well established. The pathophysiology of this is understood to be through activation of the coagulation cascade through neoplastic cells themselves or the therapy initiated (chemotherapy or surgery). To date, there have been a variety of studies, such as the OASIS-CANCER trial, which highlight the relationship of hypercoagulability to ischemic stroke. Despite these efforts, clear evidence is lacking for the utilization of antiplatelet or anticoagulation therapy in the secondary prevention of stroke following mechanical thrombectomy in patients with suspected or confirmed malignancy.
A 71-year-old female with a history of immune thrombocytopenia, diabetes mellitus, and hypertension who was undergoing an evaluation for a lung nodule, later determined to be adenocarcinoma of the lung, underwent three successful mechanical thrombectomies for acute ischemic stroke with large vessel occlusion over a one month period. This patient had improved National Institutes of Health Stroke Scale (NIHSS) scores following each of her thrombectomies. However, her history of immune thrombocytopenia and underlying malignancy complicated her discharge medication regimen following each of her thrombectomies and may have contributed to her repeat strokes.
Clear guidance is lacking regarding the utilization of antiplatelet and anticoagulation therapy in patients with suspected or confirmed malignancy following mechanical thrombectomy. Review of the literature suggests that controlling a patient's hypercoagulability may lead to improved clinical outcomes, but further clinical trials are warranted.
自特鲁索首次发表相关内容以来，与恶性肿瘤相关的血栓栓塞事件的发展已得到充分证实。其病理生理学被认为是通过肿瘤细胞自身或所启动的治疗（化疗或手术）激活凝血级联反应。迄今为止，已有多项研究，如OASIS - CANCER试验，突出了高凝状态与缺血性卒中的关系。尽管有这些努力，但对于疑似或确诊为恶性肿瘤的患者在机械取栓术后进行二级预防时使用抗血小板或抗凝治疗，仍缺乏明确证据。
一名71岁女性，有免疫性血小板减少症、糖尿病和高血压病史，正在接受肺部结节评估，后来确诊为肺腺癌，在1个月内因急性缺血性卒中伴大血管闭塞接受了3次成功的机械取栓术。该患者每次取栓术后美国国立卫生研究院卒中量表（NIHSS）评分均有所改善。然而，她的免疫性血小板减少症病史和潜在的恶性肿瘤使她每次取栓术后的出院用药方案变得复杂，可能也是导致她再次中风的原因。
对于疑似或确诊为恶性肿瘤的患者在机械取栓术后使用抗血小板和抗凝治疗，缺乏明确的指导。文献综述表明，控制患者的高凝状态可能会改善临床结局，但仍需要进一步的临床试验。
