Outcomes of Acute Ischemic Stroke in Patients with Hematological Malignancies

There is limited evidence regarding the use of acute interventions and outcomes in patients with hematological malignancies presenting with acute ischemic stroke (AIS). In this study, we aimed to evaluate the outcomes of AIS in patients with hematological malignancies.

Hospitalizations with primary diagnosis of AIS were identified from the Nationwide Readmissions Database 2016-2018. Logistic regression was used to compare differences in acute stroke interventions and clinical outcomes. Survival analysis was used to evaluate recurrent AIS after discharge.

There were 1,347,150 hospitalizations due to AIS (mean ± SD age 70.3 ± 14.1 years, female 50.2%). Of these, 11,863 (0.9%) had a concurrent diagnosis of hematological malignancy. Patients with malignancy were less likely to receive intravenous thrombolysis (tPA) but not mechanical thrombectomy (MT). Among different hematological malignancies, patients with acute leukemia and Hodgkin lymphoma had a higher likelihood of in-hospital mortality, as compared to patients without malignancy. However, among patients treated with tPA or MT, clinical outcomes were comparable between the groups. Risk of readmission due to recurrent ischemic stroke was similar between patients with and without malignancy (hazards ratio: 1.0, 95% CI: 0.9-1.1).

Patients with hematological malignancies are less likely to receive tPA but not MT; however, their use is not associated with increased harm. Patients with acute leukemias and Hodgkin lymphoma have an increased risk of in-hospital mortality, but the use of acute reperfusion therapies appears to attenuate this excess risk. Early risk of stroke recurrence is not different in patients with and without hematological malignancies.