Sato Toru, Ogihara Yoshito, Yamashita Yugo, Morimoto Takeshi, Chatani Ryuki, Kaneda Kazuhisa, Nishimoto Yuji, Ikeda Nobutaka, Kobayashi Yohei, Ikeda Satoshi, Kim Kitae, Inoko Moriaki, Takase Toru, Tsuji Shuhei, Oi Maki, Takada Takuma, Otsui Kazunori, Sakamoto Jiro, Inoue Takeshi, Usami Shunsuke, Chen Po-Min, Togi Kiyonori, Koitabashi Norimichi, Hiramori Seiichi, Doi Kosuke, Mabuchi Hiroshi, Tsuyuki Yoshiaki, Murata Koichiro, Takabayashi Kensuke, Nakai Hisato, Sueta Daisuke, Shioyama Wataru, Dohke Tomohiro, Nishikawa Ryusuke, Kimura Takeshi, Dohi Kaoru
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Res Pract Thromb Haemost. 2024 Oct 30;8(8):102617. doi: 10.1016/j.rpth.2024.102617. eCollection 2024 Nov.
Ischemic stroke is a serious complication in patients with cancer-associated venous thromboembolism (CAVTE), although data remain scarce in the direct oral anticoagulant era.
This study aimed to investigate the incidence and identify predictive risk factors of ischemic stroke in patients with CAVTE.
From the Contemporary Management and Outcomes in Patients With Venous Thromboembolism Registry-2 enrolling 5197 venous thromboembolism (VTE) patients across 31 centers in Japan between January 2015 and August 2020, we selected 1507 patients with active cancer. We calculated the cumulative incidence function of ischemic stroke accounting for the competing risk of death and investigated risk factors for ischemic stroke in a subdistribution hazard model of multivariable analysis.
During a median follow-up period of 1020 days, 71 patients (4.7%) developed ischemic stroke, and the cumulative incidence of ischemic stroke was 4.0% at 1 year and 4.7% at 3 years. Independent risk factors of ischemic stroke included pancreatic cancer (hazard ratio [HR], 4.24; 95% CI, 2.13-8.43), ovarian cancer (HR, 2.82; 95% CI, 1.31-6.08), lung cancer (HR, 2.35; 95% CI, 1.20-4.57), dyslipidemia (HR, 1.76; 95% CI, 1.01-3.09), metastasis (HR, 1.70; 95% CI, 1.02-2.82), higher D-dimer at VTE diagnosis (HR, 1.09; 95% CI, 1.04-1.14), and younger age (HR, 0.84; 95% CI, 0.71-0.999).
In this large VTE registry in the direct oral anticoagulant era, the cumulative incidence of ischemic stroke was 4.0% at 1 year and 4.7% at 3 years in patients with CAVTE, and several independent risk factors of ischemic stroke were identified, including pancreatic cancer, ovarian cancer, lung cancer, dyslipidemia, metastasis, higher D-dimer at VTE diagnosis, and younger age.
缺血性卒中是癌症相关静脉血栓栓塞（CAVTE）患者的一种严重并发症，尽管在直接口服抗凝剂时代相关数据仍然匮乏。
本研究旨在调查CAVTE患者缺血性卒中的发生率并确定其预测风险因素。
从2015年1月至2020年8月在日本31个中心招募5197例静脉血栓栓塞（VTE）患者的当代静脉血栓栓塞患者管理与结局登记-2中，我们选取了1507例活动性癌症患者。我们计算了考虑死亡竞争风险的缺血性卒中累积发病率函数，并在多变量分析的亚分布风险模型中研究了缺血性卒中的风险因素。
在中位随访期1020天期间，71例患者（4.7%）发生缺血性卒中，缺血性卒中的累积发病率在1年时为4.0%，3年时为4.7%。缺血性卒中的独立风险因素包括胰腺癌（风险比[HR]，4.24；95%置信区间[CI]，2.13 - 8.43）、卵巢癌（HR，2.82；95% CI，1.31 - 6.08）、肺癌（HR，2.35；95% CI，1.20 - 4.57）、血脂异常（HR，1.76；95% CI，1.01 - 3.09）、转移（HR，1.70；95% CI，1.02 - 2.82）、VTE诊断时较高的D - 二聚体（HR，1.09；95% CI，1.04 - 1.14）以及较年轻的年龄（HR，0.84；95% CI，0.71 - 0.999）。
在这个直接口服抗凝剂时代的大型VTE登记研究中，CAVTE患者缺血性卒中的累积发病率在1年时为4.0%，3年时为4.7%，并且确定了缺血性卒中的几个独立风险因素，包括胰腺癌、卵巢癌、肺癌、血脂异常、转移、VTE诊断时较高的D - 二聚体以及较年轻的年龄。
