Anticoagulation or Antiplatelet as Secondary Prevention for Cancer-Related Stroke?

Aug 02, 2024

Photo Credit: Mrspopman

Patients with embolic stroke of undetermined source and venous thromboembolism exclusion may have better results with anticoagulation therapy.

There was no clear difference between the use of anticoagulation and antiplatelet agents relating to the secondary prevention of cancer-related strokes, in a Swiss observational study. However, findings from a subgroup analysis suggested that patients with embolic stroke of undetermined source (ESUS) and venous thromboembolism (VTE) exclusion may benefit more from anticoagulation therapy.

“Cancer-related stroke is characterized by multi-territory infarction, specific laboratory findings, the absence of the SVS-sign, high stroke recurrence rates, and a lack of evidence for secondary prevention strategies,” outlined Dr. Moritz Kielkopf, MD, from the University of Bern, in Switzerland. The current study aimed to compare the outcomes of anticoagulation versus antiplatelet therapy in a real-world population of patients with cancer-related stroke (n=135)¹. The main study outcome was the overall mortality within 1 year after the stroke. “Of the 135 included patients, 43% were on anticoagulation and 57% received antiplatelet therapy at time of discharge,” added Dr. Kielkopf.

Patients in the anticoagulation group were generally younger (69 vs 75 years; P=0.01), had more multi-territory brain infarcts (47% vs 17%; P<0.001), more frequently had ESUS (83% vs 49%; P<0.001), were more likely to have metastatic disease (72% vs 41%), and had higher D-dimer levels (median 8,536 µg/L vs 1,010 µg/L). The uncorrected comparison between these two groups of patients showed that patients on anticoagulation had a higher 1-year mortality rate than those on antiplatelet therapy (66% vs 33%; log-rank P<0.001). The adjusted analysis did not reveal a difference in 1-year mortality for anticoagulation versus antiplatelet therapy (aHR 0.76; 95% CI 0.36–1.63; P=0.47). However, there was a trend towards a benefit of anticoagulation over antiplatelet therapy with respect to mortality among patients with ESUS and VTE exclusion (aHR 0.38; 95% CI 0.14–1.05; P=0.06).

In conclusion, there was no clear superiority of anticoagulation over antiplatelet treatment as secondary prevention therapy for cancer-related strokes. “Large-scale clinical trials are needed to further unravel this topic and to create evidence-based guidelines,” Dr. Kielkopf decided.

Medical writing support was provided by Robert van den Heuvel.