Should cerebral ischemic events in cancer patients be considered a manifestation of hypercoagulability?

Seemant Chaturvedi, Jack Ansell, Lawrence Recht

Research output: Contribution to journalArticle

77 Scopus citations

Abstract

Background and Purpose Previous studies, mainly autopsybased, suggest that the spectrum of stroke in cancer patients differs from that of the general population. These studies also suggest that cerebrovascular events frequently are a manifes­tation of hypercoagulability. However, no studies that address this question in the adult oncological population from a clinical perspective are available. We therefore assessed the clinical impact of cerebral ischemic events in cancer patients and attempted to determine whether their occurrence repre­sents a manifestation of Trousseau’s syndrome. Methods A computerized database that records all neuro­logical admissions and consultations at a tertiary medical center was used to retrospectively identify all patients with cerebral ischemic events and cancer. Results Thirty-three patients representing 3.5% of all stroke consultations and admissions seen at the University of Massachusetts Medical Center were identified during the period 1988 through 1992. Large-vessel atherosclerosis was the most frequent cause of stroke. Furthermore, although 30% were determined to have hypercoagulability as a cause using clinical criteria, in only one of nine patients in whom tests were done was sufficient evidence present to make a presumptive diagnosis of disseminated intravascular coagulation. Irrespec­tive of therapy, recurrent cerebral ischemic events were noted in only 6% of patients during a follow-up period averaging greater than 9 months, a figure that is similar to that for the risk of repeated events in the noncancer population. Conclusions Recognizing the limitations of this retrospec­tive study, it appears nonetheless that conventional stroke origins account for the majority of cerebral ischemic events in the adult cancer population. Although hypercoagulability is present to a greater extent than in the nononcological popula­tion, recurrent strokes seem to occur no more frequently than in the nononcological population, and antiplatelet agents seem sufficient therapy for most patients.

Original languageEnglish (US)
Pages (from-to)1215-1218
Number of pages4
JournalStroke
Volume25
Issue number6
DOIs
StatePublished - Jun 1994
Externally publishedYes

Keywords

  • Cerebral ischemia
  • Coagulation
  • Neoplasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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