Anticoagulation or antiplatelet as secondary prevention for cancer-related strokes?

There was no clear difference between the use of anticoagulation or antiplatelet agents relating to the secondary prevention of cancer-related strokes, in a Swiss observational study. However, findings from a subgroup analysis suggested that patients with embolic stroke of undetermined source (ESUS) and venous thromboembolism (VTE) exclusion may benefit more from anticoagulation therapy.

“Cancer-related stroke is characterised by multi-territory infarction, specific laboratory findings, the absence of the SVS-sign, high stroke recurrence rates, and a lack of evidence for secondary prevention strategies,” outlined Dr Moritz Kielkopf (University of Bern, Switzerland). The current study aimed to compare the outcomes of anticoagulation versus antiplatelet therapy in a real-world population of patients with cancer-related stroke (n=135) [1]. The main study outcome was the overall mortality within 1 year after the stroke. “Of the 135 included patients, 43% was on anticoagulation and 57% received antiplatelet therapy at time of discharge,” added Dr Kielkopf.

Patients in the anticoagulation group were generally younger (69 vs 75 years; P=0.01), had more multi-territory brain infarcts (47% vs 17%; P<0.001), more frequently had ESUS (83% vs 49%; P<0.001), were more likely to have metastatic disease (72% vs 41%), and had higher D-dimer levels (median 8,536 µg/L vs 1,010 µg/L). The uncorrected comparison between these two groups of patients showed that patients on anticoagulation had a higher 1-year mortality rate than those on antiplatelet therapy (66% vs 33%; log-rank P<0.001). The adjusted analysis did not reveal a difference in 1-year mortality for anticoagulation versus antiplatelet therapy (adjusted HR 0.76; 95% CI 0.36–1.63; P=0.47). However, there was a trend towards a benefit of anticoagulation over antiplatelet therapy concerning mortality among patients with ESUS and VTE exclusion (adjusted HR 0.38; 95% CI 0.14–1.05; P=0.06).

In conclusion, there was no clear superiority of anticoagulation over antiplatelet treatment as a secondary prevention therapy for cancer-related strokes. “Large-scale clinical trials are needed to further unravel this topic and to create evidence-based guidelines,” Dr Kielkopf decided.

1. Kielkopf M, et al. Anticoagulant versus antiplatelet treatment for secondary stroke prevention in patients with active cancer. Late-breaking session 2, 10th EAN Congress, 29 June–2 July 2024, Helsinki, Finland.

Copyright ©2024 Medicom Medical Publishers



Posted on 25 July 2024