Anticoagulants for cancer-associated ischemic stroke

Area of Science:

• Neurology
• Oncology
• Hematology

Background:

• Cancer-associated ischemic stroke shares clinical and imaging similarities with atrial fibrillation-related stroke.
• Elevated D-dimer levels are characteristic of cancer-associated hypercoagulability, unlike in atrial fibrillation stroke.
• Serum D-dimer levels correlate with mortality, prognosis, and recurrence of thromboembolism in cancer patients.

Purpose of the Study:

• To review clinical studies on cancer-associated embolic stroke.
• To propose the use of direct oral anticoagulants based on pathophysiological mechanisms.

Main Methods:

• Literature review of relevant clinical studies.
• Analysis of pathophysiological mechanisms of hypercoagulability in cancer-associated stroke.

Main Results:

• Cancer-associated stroke patients exhibit hypercoagulability indicated by increased D-dimer.
• Anticoagulants blocking the coagulation cascade, like LMWH and DOACs, may reduce hypercoagulability.
• Warfarin's mechanism may not effectively reduce hypercoagulability and could increase bleeding risk.

Conclusions:

• The treatment for cancer-associated embolic stroke remains debated.
• Direct oral anticoagulants show potential applicability in managing hypercoagulability and preventing thromboembolic events in cancer patients.