Mechanisms of Ischemic Stroke in Patients with Cancer: A Prospective Study.
Aged
Biomarkers
/ blood
Brain
/ diagnostic imaging
Cross-Sectional Studies
Female
Fibrin Fibrinogen Degradation Products
Humans
Intercellular Adhesion Molecule-1
/ blood
Ischemic Stroke
/ blood
Male
Middle Aged
Neoplasms
/ blood
Prospective Studies
Thrombomodulin
/ blood
Ultrasonography, Doppler, Transcranial
Vascular Cell Adhesion Molecule-1
/ blood
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
21
05
2021
received:
29
01
2021
accepted:
21
05
2021
pubmed:
25
5
2021
medline:
15
9
2021
entrez:
24
5
2021
Statut:
ppublish
Résumé
The objective of this study was to examine the pathophysiology of ischemic stroke with cancer. We conducted a prospective cross-sectional study from 2016 to 2020 at 2 hospitals. We enrolled 3 groups of 50 adult participants each. The main group included patients with active solid tumor cancer and acute ischemic stroke. The control groups included patients with acute ischemic stroke only or active cancer only. The patients with stroke-only and patients with cancer-only were matched to the patients with cancer-plus-stroke by age, sex, and cancer type, if applicable. The outcomes were prespecified hematological biomarkers and transcranial Doppler microemboli detection. Hematological biomarkers included markers of coagulation (D-dimer and thrombin-antithrombin), platelet function (P-selectin), and endothelial integrity (thrombomodulin, soluble intercellular adhesion molecule-1 [sICAM-1], and soluble vascular cell adhesion molecule-1 [sVCAM-1]). Hematological biomarkers were compared between groups using the Kruskal-Wallis and Wilcoxon Rank-Sum tests. In multivariable linear regression models, we adjusted for race, number of stroke risk factors, smoking, stroke severity, and antithrombotic use. Transcranial Doppler microemboli presence was compared between groups using chi-square tests. Levels of all study biomarkers were different between groups. In univariate between-group comparisons, patients with cancer-plus-stroke had higher levels of D-dimer, sICAM-1, sVCAM-1, and thrombomodulin than both control groups; higher levels of thrombin-antithrombin than patients with cancer-only; and higher levels of P-selectin than patients with stroke-only. Findings were similar in multivariable analyses. Transcranial Doppler microemboli were detected in 32% of patients with cancer-plus-stroke, 16% of patients with stroke-only, and 6% of patients with cancer-only (p = 0.005). Patients with cancer-related stroke have higher markers of coagulation, platelet, and endothelial dysfunction, and more circulating microemboli, than matched controls. ANN NEUROL 2021;90:159-169.
Identifiants
pubmed: 34029423
doi: 10.1002/ana.26129
pmc: PMC9297305
mid: NIHMS1822649
doi:
Substances chimiques
Biomarkers
0
Fibrin Fibrinogen Degradation Products
0
Thrombomodulin
0
Vascular Cell Adhesion Molecule-1
0
fibrin fragment D
0
Intercellular Adhesion Molecule-1
126547-89-5
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
159-169Subventions
Organisme : NIH HHS
ID : K23NS091395
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS091395
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NIH HHS
ID : KL2TR002385
Pays : United States
Organisme : NINDS NIH HHS
ID : L30 NS093524
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR002385
Pays : United States
Organisme : NIH HHS
ID : P30CA008748
Pays : United States
Informations de copyright
© 2021 American Neurological Association.
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