Increased Risk of Intracranial Hemorrhage and Mortality Following Thrombolysis in Patients with Stroke and Active Cancer

Abstract

Background ; The cerebrovascular disease is not uncommon in cancer patients. However, the effectiveness and safety of thrombolysis for acute ischemic stroke in this patient group has not been established well. We aimed to investigate the outcomes of thrombolysis for the patients suffering from cancer.

Methods : We conducted a retrospective analysis using database of patients who had received thrombolysis in two university hospitals. Included patients were those who had received intravenous thrombolysis or endovascular therapy. We compared mortality, and the incidence of hemorrhagic transformation (HT) and symptomatic intracerebral hemorrhage (sICH) between patients with active cancer and those without.

Results : Among a total of 627 patients, 42 (6.7%) had a medical history of active cancer. The mortality was higher in cancer patients than the others (27.5% vs. 13.7%, p=0.023). The existence of cancer was one of the factors to increases the risk of mortality (adjusted odds ratio, 3.354; 95% confidence interval, 1.416-7.947; p=0.006). From the 240 patients treated with intravenous thrombolysis only, the incidence of HT (53.8% vs. 16.3%, p=0.003), sICH (30.8% vs. 2.2%, p=0.001), and mortality (41.7% vs. 8.1%, p=0.003) was higher in cancer patients than the patients without.

Conclusion : Comorbidity with cancer raised the risk of mortality in patients when treated with thrombolysis. The patients with cancer had more bad outcomes with intravenous thrombolysis only. Our data suggest that the decision of thrombolytic treatment for cancer patients requires careful consideration.