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The Stroke Preclinical Assessment Network Multi-Laboratory Model of Thromboembolic Stroke with Thrombolysis: TE-MCAo
Published on: December 19, 2025
Acute ischemic stroke, active malignancy and non-bacterial thrombotic endocarditis: an exploratory prospective
Athanasios Frydas1,2,3,4, Ela Marie Akay5, Hong Ran1,6
1Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany.
Scientific Reports
|July 15, 2026
Summary
Active cancer patients with acute ischemic stroke (AIS) often have malignancy-associated hypercoagulability (MAH). Nonbacterial thrombotic endocarditis (NBTE), a severe MAH form, was frequently found, suggesting LMWH may be better than DOACs for anticoagulation.
Area of Science:
- Neurology
- Cardiology
- Oncology
Background:
- 3-10% of acute ischemic stroke (AIS) patients have active cancer.
- Malignancy-associated hypercoagulability (MAH) is a known cause of cancer-associated stroke.
- Nonbacterial thrombotic endocarditis (NBTE) is a severe manifestation of MAH, but its prevalence and management in AIS are not well-studied prospectively.
Purpose of the Study:
- To prospectively examine the prevalence of NBTE in patients with AIS/transient ischemic attack (TIA) and active malignancy.
- To investigate the association of NBTE with stroke patterns.
- To evaluate anticoagulation management and outcomes in this patient group.
Main Methods:
- Prospective observational study at a tertiary center.
- Included patients with AIS/TIA and active malignancy.
- Echocardiography (transthoracic and transesophageal) was performed. Data on anticoagulation and outcomes were collected.
Main Results:
- Out of 3,491 screened patients, 16 with active cancer and AIS/TIA were included.
- Eleven patients (68.8%) showed embolic patterns suggestive of MAH.
- Six patients (37.5%) were diagnosed with NBTE. NBTE patients had a higher incidence of multi-territory embolic infarctions (100% vs. 60%) and prior strokes (66.7% vs. 10%).
- Low-molecular-weight heparin (LMWH) led to vegetation resolution/regression in 3/4 patients, while direct oral anticoagulants (DOACs) were associated with progression or recurrent embolism in several patients.
- Twelve-month mortality was high in both MAH (90.9%) and NBTE (83.3%) groups.
Conclusions:
- NBTE is frequently identified in patients with cancer-associated stroke and linked to multi-territory embolic infarction.
- Early recognition of NBTE may aid diagnosis.
- Optimal anticoagulation strategies require further investigation, with preliminary findings suggesting LMWH may be more effective than DOACs.
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