Beyeler Morin, Castigliego Pasquale, Baumann Joel, Ziegler Victor, Kielkopf Moritz, Mueller Madlaine, Bauer-Gambelli Stefan A, Mujanovic Adnan, Meinel Thomas Raphael, Horvath Thomas, Fischer Urs, Kaesmacher Johannes, Heldner Mirjam R, Seiffge David, Arnold Marcel, Pabst Thomas, Berger Martin D, Navi Babak B, Jung Simon, Bücke Philipp
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
Front Neurol. 2023 Sep 28;14:1268131. doi: 10.3389/fneur.2023.1268131. eCollection 2023.
Paraneoplastic coagulopathy can present as stroke and is associated with specific biomarker changes. Identifying paraneoplastic coagulopathy can help guide secondary prevention in stroke patients, and early cancer detection might improve outcomes. However, unlike ischemic stroke, it remains unclear whether paraneoplastic coagulopathy is associated with transient ischemic attacks (TIA). This study assessed the presence of cancer-related biomarkers in TIA patients and evaluated long-term mortality rates in patients with and without active cancer.
Active cancer was retrospectively identified in consecutive TIA patients treated at a comprehensive stroke center between 2015 and 2019. An association between the presence of cancer and cancer-related biomarkers was assessed using multivariable logistic regression. Long-term mortality after TIA was analyzed using multivariable Cox regression.
Among 1436 TIA patients, 72 had active cancer (5%), of which 17 were occult (1.2%). Cancer-related TIA was associated with male gender (adjusted odds ratio [aOR] 2.29, 95% CI 1.12-4.68), history of smoking (aOR 2.77, 95% CI 1.34-5.7), elevated D-dimer (aOR 1.77, 95% CI 1.26-2.49), lactate dehydrogenase (aOR 1.003, 95% CI 1.00-1.005), lower leukocyte count (aOR 1.20, 95% CI 1.04-1.38), and lower hemoglobin (aOR 1.02, 95% CI 1.00-1.04). Long-term mortality was associated with both active cancer (adjusted hazard ratios [aHR] 2.47, 95% CI 1.58-3.88) and occult cancer (aHR 3.08, 95% CI 1.30-7.32).
Cancer-related TIA is not uncommon. Biomarkers known to be associated with cancer-related stroke also seem to be present in TIA patients. Early identification would enable targeted treatment strategies and could improve outcomes in this patient population.
副肿瘤性凝血病可表现为卒中，并与特定生物标志物变化相关。识别副肿瘤性凝血病有助于指导卒中患者的二级预防，早期癌症检测可能改善预后。然而，与缺血性卒中不同，副肿瘤性凝血病是否与短暂性脑缺血发作（TIA）相关仍不清楚。本研究评估了TIA患者中癌症相关生物标志物的存在情况，并评估了有和无活动性癌症患者的长期死亡率。
对2015年至2019年在一家综合卒中中心接受治疗的连续性TIA患者进行回顾性分析，以确定是否存在活动性癌症。使用多变量逻辑回归评估癌症的存在与癌症相关生物标志物之间的关联。使用多变量Cox回归分析TIA后的长期死亡率。
在1436例TIA患者中，72例有活动性癌症（5%），其中17例为隐匿性癌症（1.2%）。与癌症相关的TIA与男性（校正比值比[aOR]2.29，95%可信区间[CI]1.12 - 4.68）、吸烟史（aOR 2.77，95% CI 1.34 - 5.7）、D - 二聚体升高（aOR 1.77，95% CI 1.26 - 2.49）、乳酸脱氢酶（aOR 1.003，95% CI 1.00 - 1.005）、白细胞计数降低（aOR 1.20，95% CI 1.04 - 1.38）以及血红蛋白降低（aOR 1.02，95% CI 1.00 - 1.04）相关。长期死亡率与活动性癌症（校正风险比[aHR]2.47，95% CI 1.58 - 3.88）和隐匿性癌症（aHR 3.08，95% CI 1.30 - 7.32）均相关。
与癌症相关的TIA并不罕见。已知与癌症相关卒中相关的生物标志物在TIA患者中似乎也存在。早期识别将有助于制定针对性的治疗策略，并可能改善该患者群体的预后。
