Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA.
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
J Thromb Haemost. 2022 Sep;20(9):2046-2057. doi: 10.1111/jth.15779. Epub 2022 Jun 21.
Patients with cancer and acute ischemic stroke (AIS) face high rates of recurrent thromboembolism or death.
To examine whether hematologic and embolic biomarkers soon after AIS are associated with subsequent adverse clinical outcomes.
We prospectively enrolled 50 adults with active solid tumor cancer and AIS at two hospitals from 2016 to 2020. Blood was collected 72-120 h after stroke onset. A 30-min transcranial Doppler (TCD) microemboli detection study was performed. The exposure variables were hematologic markers of coagulation (D-dimer, thrombin-antithrombin), platelet (P-selectin), and endothelial activation (thrombomodulin, soluble intercellular adhesion molecule-1 [sICAM-1], soluble vascular cell adhesion molecule-1 [sVCAM-1]), and the presence of TCD microemboli. The primary outcome was a composite of recurrent arterial/venous thromboembolism or death. We used Cox regression to evaluate associations between biomarkers and subsequent outcomes.
During an estimated median follow-up time of 48 days (IQR, 18-312), 43 (86%) participants developed recurrent thromboembolism or death, including 28 (56%) with recurrent thromboembolism, of which 13 were recurrent AIS (26%). In unadjusted analysis, D-dimer (HR 1.6; 95% CI 1.2-2.0), P-selectin (HR 1.9; 95% CI 1.4-2.7), sICAM-1 (HR 2.2; 95% CI 1.6-3.1), sVCAM-1 (HR 1.6; 95% CI 1.2-2.1), and microemboli (HR 2.2; 95% CI 1.1-4.5) were associated with the primary outcome, whereas thrombin-antithrombin and thrombomodulin were not. D-dimer was the only marker associated with recurrent AIS (HR 1.2; 95% CI 1.0-1.5). Results were generally consistent in analyses adjusted for important prognostic variables.
Markers of hypercoagulability and embolic disease may be associated with adverse clinical outcomes in cancer-related stroke.
患有癌症和急性缺血性中风（AIS）的患者面临着较高的复发性血栓栓塞或死亡风险。
探讨 AIS 后不久的血液学和栓塞生物标志物是否与随后的不良临床结局相关。
我们前瞻性纳入了 2016 年至 2020 年期间在两家医院就诊的 50 例患有活动性实体瘤癌症和 AIS 的成年人。在中风发作后 72-120 小时采集血液。进行了 30 分钟的经颅多普勒（TCD）微栓子检测研究。暴露变量为凝血（D-二聚体、凝血酶-抗凝血酶）、血小板（P-选择素）和内皮细胞激活标志物（血栓调节蛋白、可溶性细胞间黏附分子-1[sICAM-1]、可溶性血管细胞黏附分子-1[sVCAM-1]）和 TCD 微栓子的存在。主要结局是复发性动脉/静脉血栓栓塞或死亡的复合事件。我们使用 Cox 回归来评估生物标志物与随后的结局之间的关联。
在估计的中位随访时间 48 天（IQR，18-312）期间，43 名（86%）参与者发生了复发性血栓栓塞或死亡，其中 28 名（56%）发生了复发性血栓栓塞，其中 13 名（26%）为复发性 AIS。在未调整分析中，D-二聚体（HR 1.6；95%CI 1.2-2.0）、P-选择素（HR 1.9；95%CI 1.4-2.7）、sICAM-1（HR 2.2；95%CI 1.6-3.1）、sVCAM-1（HR 1.6；95%CI 1.2-2.1）和微栓子（HR 2.2；95%CI 1.1-4.5）与主要结局相关，而凝血酶-抗凝血酶和血栓调节蛋白则没有。D-二聚体是唯一与复发性 AIS 相关的标志物（HR 1.2；95%CI 1.0-1.5）。在调整了重要预后变量后，分析结果基本一致。
高凝状态和栓塞性疾病的标志物可能与癌症相关中风的不良临床结局相关。
