Patients with acute ischemic stroke and concurrent lung or pancreatic cancers are more likely to suffer a recurrent stroke, suggests a study published in the journal Neurology.¹

Researchers from the United States analyzed data from 1,385,840 patients from the Nationwide Readmissions Database, who had been hospitalized with acute ischemic stroke between 2016 and 2018. A little over half of the participants were women (50.2%) and the mean age of the participants was 70.4 years. Their objective was to study the impact of solid organ malignancies on clinical outcomes during hospitalization and the risk of readmission due to recurrent stroke post-discharge.

Out of the 1,385,840 patients included in the study, 50,553 (3.7%) also had solid organ malignancy. Lung cancer was the most prevalent cancer (~25%); the other common malignancies were prostate cancer (13.2%), breast cancer (9.3%), pancreatic cancer (6.5%) and colorectal cancer (6.2%).

Patients with malignancy had higher odds of complications such as intraparenchymal hemorrhage compared to those who did not have malignancy, with an odds ratio of 1.11. They were twice more likely to die during hospitalization (OR 2.15) and had higher probability of being discharged to other facilities than discharge to home (OR 1.7). They, particularly patients with lung and pancreatic cancers, were at a higher risk of stroke recurrence and rehospitalization within one year of discharge with hazard ratio of 1.18.

A difference in acute stroke interventions was also noted in patients with cancer and those who did not have cancer. Patients with malignancy underwent mechanical thrombectomy more often than thrombolysis with intravenous tissue-type plasminogen activator (tPA). Aside from the subgroup of patients with lung cancer, the outcomes were similar between patients with and without malignancy suggesting that the two strategies were usually safe for these patients.

Cancer patients are at higher risk of stroke. This study reiterates that clinical outcomes are usually worse in patients with solid organ malignancies in the eventuality of an acute ischemic stroke with greater risk of complications, recurrent stroke and also mortality. What this study has also shown is that stroke outcomes in these patients vary according to the organ involved. Hence, patients with solid organ malignancies, in particular lung cancer and pancreatic cancer, should be carefully monitored and appropriate secondary prevention measures should be instituted to prevent stroke recurrence.

Reference

1. Garg A, et al. In-hospital outcomes and recurrence of acute ischemic stroke in patients with solid organ malignancy. Neurology Apr 2022, 10.1212/WNL.0000000000200601; DOI: 10.1212/WNL.0000000000200601