Abstract Details

Title Independent Predictors of Recurrent Thromboembolic Events in Patients with Cancer and Ischemic Stroke

Topic Neuro-oncology

Presentation(s) S35 - (-)

Poster/Presentation
Number 006

Objective

Background Patients with cancer are hypercoagulable and face a high risk of stroke and other thromboembolic events. However, the clinical factors associated with RTEs after stroke are unknown.

Design/Methods We retrospectively identified all adults admitted to Memorial Sloan-Kettering from 2006 to 2009 with active cancer and ischemic stroke. Study neurologists reviewed all electronic records for the occurrence of a post-stroke RTE, defined as a composite of recurrent ischemic stroke, TIA, MI, systemic arterial thrombosis, or DVT/PE. Based on the results of prior studies, the following clinical factors were chosen a priori as potential predictors of RTE: age, hypertension, adenocarcinoma histology, systemic metastases, unconventional stroke mechanisms, recent chemotherapy, and definite or possible marantic endocarditis. Definite marantic endocarditis required cardiac vegetation, negative blood cultures, and a radiographic cardioembolic infarct pattern; possible required an undetermined stroke mechanism and a radiographic cardioembolic infarct pattern. Multivariable logistic regression was used to evaluate the association between potential predictors and RTE.

Results Of 213 patients (mean age 67 [SD 12]; 48% women) with active cancer and acute ischemic stroke, 74 (35%) had 99 RTEs despite a median survival of only 88 days (IQR 24-435 days). Most underlying cancers originated from the lung (30%) or gastrointestinal system (27%), were adenocarcinomas (60%), and had metastasized systemically (69%). RTEs consisted of 47 DVT/PEs, 32 recurrent ischemic strokes, 9 systemic arterial thromboses, 8 MIs, and 1 TIA. Only recent chemotherapy (OR 1.64, 95% CI 1.00-2.68) was independently associated with RTE, although there were non-significant trends for definite or possible marantic endocarditis (OR 1.56, 95% CI 0.85-2.85) and unconventional stroke mechanisms (OR 1.50, 95% CI 0.82-2.73).

Conclusions Recent chemotherapy, marantic endocarditis, and unconventional stroke mechanisms may increase the risk of RTE in cancer patients with ischemic stroke.

Authors/Disclosures
Jacqueline B. Stone, MD, FAAN (Memorial Sloan-Kettering Cancer Center) PRESENTER	Dr. Stone has nothing to disclose.
Samuel Singer, MD	Dr. Singer has nothing to disclose.
Natalie T. Cheng, MD (Weill Cornell Medicine)	No disclosure on file
Alexander Merkler, MD	Dr. Merkler has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for The Neurohospitalist. Dr. Merkler has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for n/a.
Aida Orviz-García, MD (Fundacion Jimenez Diaz)	Dr. Orviz-García has nothing to disclose.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Lisa M. DeAngelis, MD, FAAN	Dr. DeAngelis has received publishing royalties from a publication relating to health care.
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MindRhythm Inc. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for multiple medicolegal firms.

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