Essibayi Muhammed Amir, Azzam Ahmed Y, Sener Ugur, Altschul David, Atik Merve, Keser Zafer
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
medRxiv. 2024 Nov 15:2024.11.14.24317340. doi: 10.1101/2024.11.14.24317340.
Ischemic stroke is common among patients with systemic malignancy, associated with increased risk of neurological deterioration and mortality compared to the general population. Optimal approach to secondary stroke prevention in cancer patients is unclear. In this meta-analysis, we evaluated available data on the use of direct oral anticoagulants (DOACs) and heparin products for stroke prevention in this population.
Using the Nested Knowledge AutoLit software, we performed PubMed search in September 2023 for articles reporting the use of antithrombotics for cancer-associated stroke. We conducted systematic review and meta-analysis. We also used a novel computational augmentation method to amplify the sample size to predict the effect before and after sample size augmentation and predict the results of further trials.
Among 253 potential studies screened, 7 were eligible for inclusion. 439 patients were treated with DOACs and 3968 with heparin products. Among patients treated with heparin, intracerebral hemorrhage (8.8 % vs 1.6, p=.02), overall hemorrhagic complications (17.9% vs 3.5%, p<.001), and mortality [28.1% vs 23.5%, p<.001] were respectively significantly higher than those reported among patients who received DOAC for cancer-associated ischemic stroke. No significant difference was observed in the rates of recurrent deep venous thrombosis, clinically significant hemorrhage, and clinical outcomes between the treatment groups. Similar results were shown with augmented meta-analysis.
This meta-analysis shows DOACs may have efficacy and safety profile similar to heparin products for recurrent stroke prevention in patients with cancer. Given the small number of studies and limited data, findings should be interpreted with caution.
缺血性卒中在全身恶性肿瘤患者中很常见，与普通人群相比，其神经功能恶化和死亡风险增加。癌症患者二级卒中预防的最佳方法尚不清楚。在这项荟萃分析中，我们评估了关于使用直接口服抗凝剂（DOACs）和肝素产品预防该人群卒中的现有数据。
我们于2023年9月使用嵌套知识自动文献软件在PubMed上搜索报告使用抗栓药物预防癌症相关卒中的文章。我们进行了系统评价和荟萃分析。我们还使用了一种新颖的计算增强方法来扩大样本量，以预测样本量增加前后的效果，并预测进一步试验的结果。
在筛选的253项潜在研究中，7项符合纳入标准。439例患者接受了DOACs治疗，3968例接受了肝素产品治疗。在接受肝素治疗的患者中，脑出血（8.8%对1.6%，p = 0.02）、总体出血并发症（17.9%对3.5%，p < 0.001）和死亡率[28.1%对23.5%，p < 0.001]分别显著高于接受DOAC治疗的癌症相关缺血性卒中患者。治疗组之间在复发性深静脉血栓形成、临床显著出血和临床结局发生率方面未观察到显著差异。增强荟萃分析显示了类似结果。
这项荟萃分析表明，在预防癌症患者复发性卒中方面，DOACs可能具有与肝素产品相似的疗效和安全性。鉴于研究数量少且数据有限，研究结果应谨慎解读。
