Burini Alessandra, Paciaroni Maurizio, D'Anna Lucio, Kuris Fedra, Maniaci Valentina, Valente Mariarosaria, Gigli Gian Luigi, Merlino Giovanni
Clinical Neurology, Department of Medicine (DMED), University of Udine, Udine, Italy.
Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy.
J Thromb Thrombolysis. 2025 Jul 17. doi: 10.1007/s11239-025-03156-5.
Cancer patients are at an increased risk for ischemic and hemorrhagic strokes. Ischemic stroke in this population often presents with distinctive features, such as cryptogenic etiology and multiple ischemic lesions, and is driven by cancer-associated coagulopathy, complicating management strategies.
We reviewed current literature on intravenous thrombolysis (IVT) for acute ischemic stroke in cancer patients through PubMed search with no time limits. We included international guidelines, meta-analyses, cohort studies, and case series to evaluate its safety and efficacy. This descriptive review aims to evaluate the risks and benefits of thrombolytic treatment in patients with acute stroke and cancer.
Despite limited high-quality evidence (no randomized trial), studies suggest that IVT is generally safe and effective in cancer patients with ischemic stroke. However, treatment should be individualized, considering specific contraindications and the patient's tumor characteristics. The 2019 American Heart Association/American Stroke Association guidelines contraindicate IVT in patients with gastrointestinal or intra-axial tumors; conversely, these conditions are not explicitly mentioned in the 2021 European Stroke Organization guidelines, as recent studies have not proven them to be at higher risk per se. Particular attention should be given to coagulation abnormalities, recent surgery, and concomitant medications. Thus, cautious and multidisciplinary management is needed. Further research is essential to define risk stratification for this complex population better. Multicentered, well-designed prospective studies are crucial and should also differentiate patients based on tumor site, histology, and molecular characteristics that could impact both thrombotic and hemorrhagic risk.
癌症患者发生缺血性和出血性卒中的风险增加。该人群中的缺血性卒中常表现出独特特征，如隐源性病因和多发缺血性病灶，且由癌症相关凝血病所致，这使管理策略变得复杂。
我们通过在PubMed上无时间限制地检索，回顾了关于癌症患者急性缺血性卒中静脉溶栓（IVT）的当前文献。我们纳入了国际指南、荟萃分析、队列研究和病例系列，以评估其安全性和有效性。本描述性综述旨在评估急性卒中和癌症患者溶栓治疗的风险和益处。
尽管高质量证据有限（无随机试验），但研究表明IVT在患有缺血性卒中的癌症患者中总体上是安全有效的。然而，治疗应个体化，考虑特定的禁忌证和患者的肿瘤特征。2019年美国心脏协会/美国卒中协会指南将胃肠道或轴内肿瘤患者的IVT列为禁忌；相反，2021年欧洲卒中组织指南未明确提及这些情况，因为近期研究尚未证明它们本身具有更高风险。应特别关注凝血异常、近期手术和伴随用药。因此，需要谨慎的多学科管理。进一步的研究对于更好地定义这一复杂人群的风险分层至关重要。多中心、精心设计的前瞻性研究至关重要，还应根据可能影响血栓形成和出血风险的肿瘤部位、组织学和分子特征对患者进行区分。
