Safety and outcome of rtPA in acute ischemic stroke in patients with active cancer: case-control study

T. Geraldes, L. Pereira, C. Guarda, M. Grunho, A.C. Ribeiro, J. Coimbra, I. Mendes, M. Rodrigues [REV NEUROL 2017;65:13-18] PMID: 28650062 DOI: https://doi.org/10.33588/rn.6501.2016510 OPEN ACCESS
Volumen 65 | Number 01 | Nº of views of the article 21.740 | Nº of PDF downloads 588 | Article publication date 01/07/2017
Icono-PDF-OFF Download PDF Castellano Icono-PDF-OFF Download PDF English Citation Search in PubMed
Share in: Facebook Twitter
Go to another issue
ABSTRACT Artículo en español English version
INTRODUCTION Cancer patients have increased stroke risk from direct and indirect malignancy effects. Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is standard medical treatment for acute ischemic stroke (AIS).

AIM To review rtPA use in AIS patients with active cancer.

SUBJECTS AND METHODS Retrospective observational case-control study evaluating patients with AIS and cancer admitted to our stroke unit between January/2010 and June/2015.

RESULTS Seven cases were identified (86% male; median age: 76), and 20 controls were included matched for age and Oxfordshire Community Stroke Project classification. 29% experienced direct procedure complications vs 30% within the control group, 14% suffered haemorrhagic transformation (vs 20%), one patient experienced serious systemic haemorrhage (case) and one patient experienced serious intracerebral haemorrhage (control). After three months’ follow-up, 43% were independent compared with 25% controls, and 29% had died (vs 30%). Undetermined aetiology subtype (TOAST classification) was more frequent in cancer patients when compared to controls (71% vs 20%). CONCLUSION. Severe haemorrhagic complications, potentiated by rtPA, carry increased risk of morbidity and mortality. Nevertheless, selected cancer patients with AIS may benefit from rtPA treatment. Active cancer should not be considered an absolute contraindication to rtPA use. Risk of complications and life expectancy should be assessed when making this decision.
KeywordsCancerOutcomertPASafetyStrokeThrombolysis CategoriesCáncer y tumoresPatología vascular
FULL TEXT Artículo en español English version