Nakajima Sho, Kawano Hiroyuki, Yamashiro Kazuo, Tanaka Ryota, Kameda Tomoaki, Kurita Naohide, Hira Kenichiro, Miyamoto Nobukazu, Ueno Yuji, Watanabe Masao, Hirano Teruyuki, Fujimoto Shigeru, Urabe Takao, Hattori Nobutaka
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan.
Front Neurol. 2022 Apr 4;13:868137. doi: 10.3389/fneur.2022.868137. eCollection 2022.
Hypercoagulability is associated with increased risks of ischemic stroke and subsequent mortality in patients with active cancer. This study investigated the relationships between plasma D-dimer levels after stroke treatment and short-term outcomes in patients with cancer-associated stroke.
This retrospective, observational, multicenter study analyzed consecutive patients with cancer-associated ischemic stroke. Hypercoagulability was assessed by plasma D-dimer levels before and after stroke treatment. Short-term outcomes were assessed in terms of poor outcomes (a modified Rankin Scale score >3), cumulative rates of recurrent ischemic stroke, and mortality at 30 days after admission.
Of 282 patients, 135 (47.9%) showed poor outcomes. Recurrent ischemic stroke was observed in 28 patients (9.9%), and the cumulative mortality rate was 12.4%. Multivariate analysis showed that post-treatment plasma D-dimer levels ≥10 μg/ml were independently associated with both poor outcomes (adjusted odds ratio [OR], 9.61; 95% confidence interval [CI], 3.60-25.70; < 0.001) and mortality (adjusted OR, 9.38; 95% CI, 3.32-26.44; < 0.001). Pre-treatment plasma D-dimer levels ≥10 μg/ml were not associated with these outcomes. Patients who received heparin had higher pre-treatment plasma D-dimer levels than those treated with other anticoagulants. Heparin produced a significant reduction in D-dimer levels from pre- to post-treatment without increasing the incidence of hemorrhagic events.
A high plasma D-dimer level after stroke treatment was associated with poor short-term outcomes in patients with cancer-associated stroke. Using anticoagulants to reduce D-dimer levels may improve short-term outcomes in these patients.
高凝状态与活动性癌症患者缺血性卒中风险增加及后续死亡率升高相关。本研究调查了癌症相关性卒中患者卒中治疗后血浆D - 二聚体水平与短期预后的关系。
这项回顾性、观察性、多中心研究分析了连续性癌症相关性缺血性卒中患者。通过卒中治疗前后的血浆D - 二聚体水平评估高凝状态。短期预后根据不良预后（改良Rankin量表评分>3）、复发性缺血性卒中累积发生率以及入院后30天死亡率进行评估。
282例患者中，135例（47.9%）预后不良。28例患者（9.9%）发生复发性缺血性卒中，累积死亡率为12.4%。多因素分析显示，治疗后血浆D - 二聚体水平≥10μg/ml与不良预后（调整优势比[OR]，9.61；95%置信区间[CI]，3.60 - 25.70；P < 0.001）和死亡率（调整OR，9.38；95%CI，3.32 - 26.44；P < 0.001）均独立相关。治疗前血浆D - 二聚体水平≥10μg/ml与这些预后无关。接受肝素治疗的患者治疗前血浆D - 二聚体水平高于接受其他抗凝剂治疗的患者。肝素使治疗前后D - 二聚体水平显著降低，且未增加出血事件发生率。
癌症相关性卒中患者卒中治疗后血浆D - 二聚体水平升高与短期预后不良相关。使用抗凝剂降低D - 二聚体水平可能改善这些患者的短期预后。
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