Abstract Details

Title The Risk of ICH in Cancer Patients Treated with Intravenous Thrombolysis for Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P06 - (-)

Poster/Presentation
Number 263

Objective

Background BACKGROUND: Cancer patients are at increased risk for acute ischemic stroke (AIS). Thrombolytic therapy for AIS is effective but carries a risk of intracranial hemorrhage (ICH). To date, we have limited knowledge regarding t-PA safety and efficacy for cancer patients.

Design/Methods DESIGN/METHODS: Retrospective study of consecutive AIS patients treated with I.V t-PA (n=117) between 2008 to 2011 in TASMC. Baseline clinical and demographic were taken from our prospective stroke registry. Baseline and follow-up CT scan were re-evaluated retrospectively. Active cancer patients were defined as patients undergoing treatment for malignancy during index AIS admission, those with metastatic disease, and those refusing cancer treatments.

Results RESULTS: 117 patients were treated with IV t-PA for AIS. Nine patients (7.7%) had active cancer. At discharge cancer patients had higher median mRS and were 9.7 more likely to suffer from poor outcome. Major ICH was observed in 5/9 (55%) cancer and 11/107 (10.3%) non-cancer patients. After performing Logistic regression, major ICH was independently associated with active cancer (p 0.005, OR 8.432, CI [1.88-37.65]), INR (p 0.02, OR 1.7, CI [1.08-2.27]). NIHSS was borderline significant (p 0.06, OR 1.1, CI[0.99-1.2]). Cancer patients were 9.7 times more likely to suffer ICH (p<0.0001).

Conclusions CONCLUSIONS: Active cancer was independently associated with increased in ICH after I.V t-PA for AIS. In fact, more than 50% of our cancer patients developed ICH - an unacceptable rate. The underlying mechanism could represent cogulopathy due to micro-metastases to the liver and alternation in coagulation factor production; micro brain metastases with alternation of the blood brain barrier (BBB) and increase tendency of bleeding. Our results need further confirmation before clinical recommendations can be made. In the meanwhile, extra caution should be taken when considering tPA treatment for active cancer patients.

Authors/Disclosures
Hadar Kolb PRESENTER	Hadar Kolb has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Hadar Kolb has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Hadar Kolb has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for MAPI pharma. Hadar Kolb has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neopharm Scientific. Hadar Kolb has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Marck. The institution of Hadar Kolb has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MAPI pharma. Hadar Kolb has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medison pharma. Hadar Kolb has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Marck.
	No disclosure on file
	No disclosure on file
Hen Hallevi, MD (Dept of Neurology)	No disclosure on file
	No disclosure on file

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