Patients with malignancy had higher mortality rates and were less likely to receive tPA.
Patients with acute ischemic stroke and a preexisting cancer diagnosis are more likely to die in the hospital and less likely than those without a malignancy to receive IV tPA, but both groups receive mechanical thrombectomy at the same rate, according to a new study.
“These findings are important as they highlight the fact that an active malignancy is a poor prognostic marker among acute ischemic stroke patients, even in the immediate post-stroke hospitalization period,” write Lorenzo Rinaldo, MD (Mayo Clinic Rochester, MN), and colleagues in their paper published online January 2, 2019, ahead of print in the Journal of NeuroInterventional Surgery.
Despite some prior data, there is a “relative paucity of information on the association between malignancy and immediate outcomes after acute ischemic stroke,” including those of patients with malignancies who are treated with IV tPA and mechanical thrombectomy, the authors note.
For their study, Rinaldo and colleagues used a national database from 351 institutions reporting the outcomes of 318,127 admissions for acute ischemic stroke to compare results between those with and without concomitant malignancy.
Overall, 16,141 patients had a preexisting diagnosis of malignancy at the time of hospital admission. As a group, they were significantly less likely than those without a malignancy to receive IV tPA (7.3% vs 10.7%; P < 0.001) and as likely to receive mechanical thrombectomy (3.1% vs 3.1%; P = 0.967).
Of note, patients with a brain malignancy were less likely to receive IV tPA (2.5% vs 10.5%; P < 0.001) and mechanical thrombectomy (2.1% vs 5.4%; P < 0.001) than those with malignancies of non-CNS origin. Cancer patients also were less likely to be discharged home
The study also found that in-hospital mortality rates were higher overall and by treatment subgroup inpatients with malignancies compared with no malignancies.
In-Hospital Mortality
|
|
Malignancy |
No Malignancy |
P Value |
|
All Patients |
7.1% |
3.7% |
< 0.001 |
|
IV tPA Subgroup |
10.8% |
6.1% |
< 0.001 |
|
Thrombectomy Subgroup |
20.3% |
13.5% |
< 0.001 |
“The detrimental effect of malignancy did not appear to be secondary to hemorrhagic complications, although information on other types of complications was lacking,” the study authors write. “Previous studies identified worsening of preexisting medical comorbidities as a significant driver of mortality in patients with concurrent malignancy, and thus overall disease burden was likely a contributing factor to worse outcomes in these patients.”
Rinaldo and colleagues add that further work is needed to determine optimal management strategies for patients with cancer and acute ischemic stroke.
Source:
Rinaldo L, Cloft HJ, Rangel Castilla L, et al. Utilization rates of tissue plasminogen activator and mechanical thrombectomy in patients with acute stroke and underlying malignancy. J NeuroInterv Surg. 2019;Epub ahead of print.
Disclosures:
Rinaldo reports no relevant conflicts of interest.
