Pure Thalamic Infarct: 8-Year Follow-Up Study in a Hospital in China

Pure thalamic infarct is a rare lacunar stroke type, with little known about long-term outcomes. This 8-year, single-center, retrospective study evaluated the clinical background, etiology, Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, and 8-year follow-up results in 27 patients with pure thalamic infarcts identified by MR diffusion-weighted imaging in Dalian, China. All patients presented chief complaints of limb weakness or sensory disturbances. Hypertension (24/27, 88.9%), diabetes (12/27, 44.4%), atrial fibrillation (1/27, 3.7%), hyperlipidemia (10/27, 37%), hyperhomocysteinemia (6/27, 22.2%), smoking history (10/27, 37%; 9/15, 60% for men; 1/12, 8.3% for women), and excessive alcohol consumption history (7/27, 25.9%; 7/15, 46.7% for men; 0 for women) were observed in our patient population. Based on TOAST classification, 1 patient had large artery atherosclerosis (7.14%), 23 had small vessel occlusion (SVO; 85.2%), and 3 patients were unidentified due to lack of cerebral angiography. The thalamic blood supply classification were as follows: 23 (85.2%), inferolateral territory; 1 (3.7%), tuberothalamic territory; 2 (7.4%), combination of tuberothalamic and paramedian arteries; 1 (3.7%), combination of inferolateral and paramedian arteries; 0, posterior choroidal arteries. During the 8-year follow-up, 3 patients died of colon cancer, multi-organ failure, and kidney failure, respectively; 7 presented with a recurrent stroke; while 10 recovered well with their risk factors under control. In conclusion, our cohort of pure thalamic infarcts were mainly due to SVO (TOAST), with hypertension as the main risk factor, and the inferolateral artery as the most implicated arterial territory. Less severe outcome or stroke recurrence are identified in long-term follow-up of pure thalamic infarcts. Other comorbidities would be cause of death in aged patients.

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Abstract TP127: Mortality and Recurrence in Atherosclerotic Ischemic Stroke: Long-term Follow-up

Stroke ◽

10.1161/str.48.suppl_1.tp127 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Miguel A Barboza ◽

Rodrigo Uribe ◽

Fabiola Serrano ◽

Luis C Becerra-Pedraza ◽

D. K Mantilla-Barbosa ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Median Time ◽

Smoking History ◽

Stroke Recurrence ◽

Active Smoking ◽

Long Term Outcome ◽

Long Term Follow Up

Background and purpose: Atherosclerotic ischemic stroke is the second most frequent etiology of stroke in the adult population. Functional outcome, mortality and recurrence of stroke rates on the long-term follow-up are poorly studied. This study investigates long-term outcome among patients with ischemic stroke secondary to atherosclerotic causality, and identifies the main factors associated with poor outcome, recurrence, and death. Methods: We analyzed data from our consecutive acute ischemic stroke database, over a period of 25 years (1990-2015). The endpoints were: bad outcome (Modified Rankin Score ≥3), recurrence and mortality at discharge, and final follow-up. Multivariate Cox and Kaplan-Meier analysis were used to estimate the probability of death and recurrence. Results: A total of 946 consecutive atherosclerotic stroke patients were included (571 [60.4%] males, median age 65 years [interquartile range 57-73 years] for the entire population); dyslipidemia (64.2%), hypertension (63.3%), diabetes (35.0%), and active smoking history (31.8%) were the most prevalent risk factors.After a median follow-up of 38 months (IQR 12-75 months), 59.3% patients had a bad outcome at discharge. A result of 26.1% had stroke recurrence (median time until recurrence: 9 months [IQR 12-84 months], with 12.9% cases presenting ≥2 recurrences), and 24.1% were dead (median time to death: 18.5 months [IQR 11-74 months]) at the final follow-up period. After multivariate adjustment, hypertension (HR 4.2, CI 95% 2.8-6.1; p<0.001) was the strongest predictor of recurrence. Additionally, diabetes (HR 2.6, CI 95% 2.0-3.5; p<0.001), bad functional outcome after recurrence (HR 2.3, CI 95% 1.9-2.9; p<0.001), age ≥65 years (HR 2.2, CI 95% 1.7-2.9; p<0.001), and active smoking (HR 1.8, CI 95% 1.3-2.3; p<0.001) were the strongest predictors of mortality. Conclusions: Atherosclerotic ischemic stroke has a high rate of recurrence, associated mainly with hypertension. Mortality is predicted by diabetes, bad functional outcome at recurrence, and older age.

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Abstract 1122‐000226: Collaborative Stroke Pathway for In‐Patient Implantation of Long‐Term Cardiac Rhythm Monitors for Atrial Fibrillation Detection

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000226 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Priyadarshee Patel ◽

Alfredo Munoz ◽

Elan Miller ◽

Shaista Alam ◽

Robin Dharia ◽

...

Keyword(s):

Atrial Fibrillation ◽

Collaborative Care ◽

Cardiac Rhythm ◽

Care Pathway ◽

Cryptogenic Stroke ◽

Stroke Recurrence ◽

Large Artery ◽

Lost To Follow Up

Introduction : Atrial fibrillation (AF) is a recognized risk factor of ischemic stroke and AF‐related stroke is twice more likely to prove fatal. Long‐term cardiac rhythm monitoring has greater diagnostic yield compared to conventional monitoring in detecting AF. Utility of implantable loop recorder (ILR) in detecting AF was established not only in patients with cryptogenic stroke but more recently in strokes due large artery atherosclerosis and small vessel disease Stroke AF trial. We present a collaborative care pathway and share multi‐year data on ILR implantation. Methods : A review of prospectively collected registry of ILR implantations performed at a Comprehensive stroke center was conducted. Data from 2017–2019 of in‐patient and out‐patient implantation was analyzed. Eligible patients identified by vascular neurology (VN) underwent in‐patient implantation primarily by interventional neurology (IN) and as out‐patient by electrophysiology Cardiology. In‐patient implant and programming were done on the day of discharge. Continuous monitoring was followed by EP Cardiology. AF detection was urgently communicated by EP Cardiology and anticoagulation initiated by VN. Patients lost to follow up or lacking information in medical records were excluded from analysis. Results : Total of 428 ILR implantations were performed over a period of 3 years (1/2017 ‐ 12/2019) with majority implants as in‐patient prior to discharge 290 (67.8%) and out‐patient 78 (32.2%). Inpatient ILR placement was noted to be 75% in 2017, 78% in 2018 and 80% in 2019. 57.2% of in‐patient ILRs were placed by IN and 42.8% by EP. Average time to in‐patient ILR was 4.1 days with 77% within 5, 18.5% within 10, and <5% within 11 or more days post‐stroke. Average time to out‐patient ILR placement was 57 days with only 16% within 15, 29% within 30 day and 53% in more than 30 days from stroke. Over the course of 2 years of monitoring, AFib was detected in 33% with false detection in 1.5% (19.6% in 2017, 26% in 2018 and 36.5% in 2019). Conclusions : A multispecialty collaborative care pathway to increase implantation rate in eligible patients is recommended. In‐patient implantation allows establishing continuity of care, patient retention, prevents lost to follow‐up, avoids delay in monitoring, and importantly decreases the risk of stroke recurrence by early initiation of anticoagulation.

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Abstract 3131: Impact of Undetermined or Other Determined Categories by TOAST on Prognosis After Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3131 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Dohoung Kim ◽

Seung-Hoon Lee ◽

Beom Joon Kim ◽

Keun-Hwa Jung ◽

Kyung-Ho Yu ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Large Artery ◽

Stroke Treatment ◽

Stroke Subtypes ◽

Preventive Medication ◽

Ischemic Attack ◽

Long Term Mortality

Background: A few studies have suggested that stroke subtypes influence the long-term mortality following ischemic stroke. However, the outcome in patients with strokes of undetermined or other determined etiology (OD) has not yet been elucidated. Method: We prospectively enrolled acute ischemic stroke and transient ischemic attack patients from 29 hospitals in Korea over a 9-year period. The Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria was used to classify stroke subtype. Stroke of undetermined etiology was further divided into 1) 2 or more cause, 2) negative etiology, and 3) incomplete evaluation (UI). We analyzed the demographics, risk factors, duration of admission, functional outcomes at discharge, 30-day mortality, and any cause mortality after stroke. Results: A total of 38,875 patients with ischemic stroke and transient ischemic attack were included in this study. Thirty-day mortality was 3.8%, and overall mortality at the end of follow-up was 23.2%. Mean follow-up duration was 1032±780 days. Thirty-day mortality and long-term mortality was highest in UI group (14.9% and 41.4%, respectively) among all stroke subtypes. The OD and UI subtype was a powerful predictor of 30-day mortality [for OD: odds ratio (OR) 2.18, 95% confidence interval (CI) 1.37-3.47; for UI: OR 3.30, 95% CI 2.65-4.10; large-artery atherosclerosis as a reference] after control of all possible confounders. In addition, the OD and UI subtype was an independent predictor of death during the follow-up [for OD: hazard ratio (HR) 1.81, 95% CI 1.49-2.20; for UI: HR 1.59, 95% CI 1.45-1.74; large-artery atherosclerosis as a reference]. Other independent predictors of long-term mortality were age, sex, body mass index, history of prior stroke, diabetes, dyslipidemia, NIHSS on admission, intrahospital treatment of thrombolytics, and second preventive medication at discharge. Conclusion: Our study on subgroups of undetermined and other determined etiology showed heterogenous prognosis.

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Long-term neurological, vascular, and mortality outcomes after stroke

International Journal of Stroke ◽

10.1177/1747493018798526 ◽

2018 ◽

Vol 13 (8) ◽

pp. 787-796 ◽

Cited By ~ 11

Author(s):

Ravinder-Jeet Singh ◽

Shuo Chen ◽

Aravind Ganesh ◽

Michael D Hill

Keyword(s):

Acute Stroke ◽

Recurrent Stroke ◽

Intravenous Thrombolysis ◽

Stroke Recurrence ◽

Stroke Survivors ◽

Acute Stroke Care ◽

Term Outcome ◽

Long Term Outcome ◽

Stroke Treatment

Background Despite improved survival and short-term (90-day) outcomes of ischemic stroke patients, only sparse data exist describing the sustained benefits of acute stroke care interventions and long-term prognosis of stroke survivors. Aim We review the contemporary literature assessing long-term (5 years or more) outcomes after stroke and acute stroke treatment. Summary of review Acute stroke unit care and intravenous thrombolysis have sustained benefits over longer follow-up, but few data exist on the long-term outcome after endovascular thrombectomy (EVT). A large proportion of stroke survivors face challenges of residual disability and neuropsychiatric sequelae (especially affective disorders and epilepsy) which affects their quality of life and is associated with poorer prognosis due to increase in stroke recurrences/mortality. Nearly, a quarter of stroke survivors have a recurrent stroke at 5 years, and nearly double that at 10 years. Mortality after recurrent stroke is high, and half of the stroke survivors are deceased at 5 years after stroke and three fourth at 10 years. Long-term all-cause mortality is largely due to conditions other than stroke. Both stroke recurrence and long-term mortality are affected by several modifiable risk factors, and thus amenable to secondary prevention strategies. Conclusions There is a need for studies reporting longer term effects of acute interventions, especially EVT. Better preventive strategies are warranted to reduce the vascular and non-vascular mortality long after stroke.

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Association between physical exercise and stroke recurrence among first-ever ischemic stroke survivors

Scientific Reports ◽

10.1038/s41598-021-92736-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lisha Hou ◽

Mier Li ◽

Ju Wang ◽

Yawen Li ◽

Qianwen Zheng ◽

...

Keyword(s):

Ischemic Stroke ◽

Exercise Duration ◽

Stroke Recurrence ◽

Stroke Survivors ◽

Face To Face ◽

Baseline Information ◽

Exercise Type ◽

The Relationship

AbstractThe relationship between exercise and stroke recurrence is controversial. This study was designed to test whether an association exists between exercise and ischemic stroke recurrence in first-ever ischemic stroke survivors. Data were collected from January 2010 to June 2016. Baseline information was obtained during face-to-face interviews, and follow-up phone interviews were conducted every 3 months. Exercise type, frequency, intensity, and duration were recorded. Discrete-time survival analysis was used to determine the relationship between exercise and stroke recurrence. 760 first-ever ischemic stroke survivors who were able to exercise were enrolled. After adjusting for covariates, patients who exercised 3.5–7 h per week and more than 7 h per week had a lower relapse risk than patients who did not exercise (3.5–7: OR 0.415; > 7: OR 0.356). Moreover, if the fluctuation of exercise duration was over 4 h, the patients had a higher risk of stroke recurrence than those with variability of less than 2 h (OR 2.153, P = 0.013). Stroke survivors who engage in long-term regular mild exercise (more than 5 sessions per week and lasting on average 40 min per session) have a lower recurrence rate. Irregular exercise increases the risk of stroke recurrence.

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Abstract TP438: Japanese versus Non-Japanese Patients With Transient Ischemic Attack or Minor Stroke: Five-Year Risk of Stroke and Vascular Events

Stroke ◽

10.1161/str.51.suppl_1.tp438 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Shinichiro Uchiyama ◽

Takao Hoshino ◽

Hugo Charles ◽

Kenji Kamiyama ◽

Taizen Nakase ◽

...

Keyword(s):

Intracranial Hemorrhage ◽

Transient Ischemic Attack ◽

Japanese Patients ◽

Minor Stroke ◽

Stroke Recurrence ◽

Large Artery ◽

Vascular Events ◽

Minor Ischemic Stroke ◽

Ischemic Attack

Background: We have reported 5-year risk of stroke and vascular events after a transient ischemic attack (TIA) or minor ischemic stroke in patients enrolled into the TIAregistry.org, which was an international multicenter-cooperative, prospective registry (N Engl J Med 2018;378:2182-90). We conducted subanalysis on the 5-year follow-up data of Japanese patients in comparison with non-Japanese patients. Methods: The patients were classified into two groups on ethnicity, Japanese (n=345) and non-Japanese (n=3502), and their 5-year event rates were compared. We also determined predictors of five-year stroke in both groups. Results: Death from vascular cause (0.9% vs 2.7%, HR 0.28, 95% CI 0.09-0.89, p=0.031) and death from any cause (7.8% vs 9.9%, HR 0.67, 95% CI 0.45-0.99, p=0.045) were fewer in Japanese patients than in non-Japanese patients, while stroke (13.9% vs 7.2%, HR 1.78, 95% CI 1.31-2.43, p<0.001) and intracranial hemorrhage (3.2% vs 0.8%, HR 3.61. 95% CI 1.78-7.30, p<0.001) were more common in Japanese than non-Japanese patients during five-year follow-up period. Caplan-Meyer curves at five-years showed that the rates of stroke was also significantly higher in Japanese than non-Japanese patients (log-rank test, p=0.001). Predictors for stroke recurrence at five years were large artery atherosclerosis (HR 1.81, 95% CI 1.31-2.52, p<0.001), cardioembolism (HR 1.71, 95% CI 1.18-2.47, p=0.004), multiple acute infarction (HR 1.77, 95% CI 1.27-2.45, p<0.001) and ABCD 2 score 6 or 7 (HR 1.96, 95% CI 1.38-2.78, p<0.001) in non-Japanese patients, although only large artery atherosclerosis (HR 3.28, 95% CI 1.13-9.54, p=0.029) was a predictor for stroke recurrence in Japanese patients. Conclusions: Recurrence of stroke and intracranial hemorrhage were more prevalent in Japanese than non-Japanese patients. Large artery atherosclerosis was a predictor for stroke recurrence not only in non-Japanese patients but also in Japanese patients.

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Abstract 17130: Variables Associated With Uncontrolled Blood Pressure Early After Stroke

Circulation ◽

10.1161/circ.138.suppl_1.17130 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Saviour Achilike ◽

Austin Wang ◽

Gabretta Cooksey ◽

Evelyn Hinojosa ◽

Munachi Okpala ◽

...

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Recurrent Stroke ◽

Stroke Recurrence ◽

Uncontrolled Blood Pressure ◽

Factors Associated ◽

Multivariable Analyses ◽

Medication Complexity ◽

Ischemic Attack

Introduction: Uncontrolled blood pressure (BP) is a major risk factor for recurrent stroke; however, up to 50% of stroke survivors have uncontrolled BP 6 months after stroke. Characterization of factors associated with uncontrolled BP early after stroke discharge (DC) may help to identify patients for BP interventions. Hypothesis: We sought to identify factors associated with uncontrolled BP in the first month after stroke discharge. We hypothesized that African American (AA) race, insurance status, medication complexity, and hospital BP prior to discharge would be associated with uncontrolled BP. Methods: We identified hypertensive patients with ischemic or hemorrhagic stroke or transient ischemic attack scheduled to follow-up in the stroke clinic 2 to 4 weeks after hospital DC. Office BP was obtained using BpTRU, an automated machine that averages five unattended BP measures. Uncontrolled BP was defined using 2017 American College of Cardiology Guidelines as BP ≥ 130/80 mmHg. We used univariate logistic regression to assess relationships between uncontrolled BP and selected variables. Variables with statistically significant associations in the univariate models and variables associated with uncontrolled BP in the literature were included in the multiple logistic regression model. Results: Of the 230 patients identified, 55.7% had uncontrolled BP at clinic follow-up. In univariate and multivariable analyses, AA race, young stroke (age < 50), and systolic BP (SBP) 24-hours prior to DC were significantly associated with uncontrolled BP early after stroke DC. BP medication complexity was not associated with uncontrolled BP in this study. Conclusions: AA race, young age, and elevate SBP in the 24 hours prior to of stroke DC were associated with uncontrolled BP early after stroke. These variables can be used to identify patients who may benefit from early interventions aimed at reducing the risk of uncontrolled BP after stroke and stroke recurrence.

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Abstract P132: Clinical Outcomes In Ischemic Stroke Patients With Uncontrolled Hypertension

Hypertension ◽

10.1161/hyp.78.suppl_1.p132 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Zahra Abuzaid ◽

Sara Almuslem ◽

Farah Aleisa

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

Recurrent Stroke ◽

Uncontrolled Hypertension ◽

Stroke Recurrence ◽

Stroke Patients ◽

Stroke Event ◽

Uncontrolled Blood Pressure

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

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Abstract TP124: 90-Day Disability Outcomes and Stroke Etiology: An ALIAS 2 Secondary Analysis

Stroke ◽

10.1161/str.51.suppl_1.tp124 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Eric D Goldstein ◽

Vivek K Reddy ◽

Stephanie Lyden ◽

Jennifer J Majersik ◽

Adam de Havenon

Keyword(s):

Univariate Analysis ◽

Secondary Analysis ◽

Large Artery ◽

Logistic Regression Models ◽

Stroke Etiology ◽

Disability Outcome ◽

Toast Classification ◽

Iv Tpa ◽

Toast Criteria

Background: Acute ischemic stroke (AIS) treatment remains a leading cause of global morbidity and mortality despite advancements in therapeutic options. Cardioembolic AIS had previously been associated with the greatest long-term disability and mortality. Our aim is to provide an updated perspective of 90-day disability outcomes with regard to stroke etiology. Methods: This is a secondary analysis of the ALIAS 2 trial. The primary outcome was the 90-day mRS. Stroke etiology was defined based on TOAST criteria. Spearman’s Rho is used to determine correlation between etiology and mRS. Univariate and multivariate logistic regression models are fit to a binary stratification of our outcome (mRS 0-1 vs 2-6). Results: A total of 776 patients were enrolled between 2009 and 2012 with a mean (SD) age of 64.7 (12.7) years. The median (IQR) NIHSS was 11 (8, 17) with 55.3% being male, 76.7% white, and 89.7% having received IV TPA. Large artery atherosclerosis (LAA) (201/776, 25.9%), cardioembolism (271/776, 34.9%) and cryptogenic (196/776, 25.3%) were the most common AIS etiologies. The 90-day mRS had significant differences by TOAST category (rho = 0.013, p<0.001). Individuals with LAA had the highest mean 90-day mRS (Figure 1). LAA was associated with lower odds of good outcome in both univariate analysis (OR 0.68, 95% CI 0.48-0.96) and in a multivariate model (OR 0.66, 95% CI 0.45-0.97) adjusted for age, NIHSS, diabetes, hypertension, hyperlipidemia, sex, white race and administration of IV TPA. Conclusion: Our secondary analysis revealed that AIS with a NIHSS greater than 8 of LAA origin purported a worse 90-day disability outcome. This data may serve to remind clinicians that AIS from LAA may yield comparable or greater disability than cardioembolic AIS. Figure 1: Mean 90-day disability outcome based on TOAST classification. LAA purported worse mean disability outcomes compared to other grouped etiologies.

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Abstract P684: Treatment of Hypercoagulability-Induced New Neurovascular Events Using Enoxaparin vs DOACs (THINNED): A Retrospective Study

Stroke ◽

10.1161/str.52.suppl_1.p684 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Danielle Golub ◽

Sakinah Sabadia ◽

Shadi Yaghi ◽

Aneek Patel ◽

Christopher Hernandez ◽

...

Keyword(s):

Ischemic Stroke ◽

Cancer Patients ◽

Metastatic Disease ◽

Recurrent Stroke ◽

Antiplatelet Agent ◽

Retrospective Chart Review ◽

Initial Study ◽

Stroke Recurrence ◽

Vessel Infiltration

Introduction: The incidence of stroke is higher in patients with malignancy, especially within a few months of diagnosis and in more aggressive cancers. This phenomenon may be explained by an inherent hypercoagulable state, tumor embolism, vessel infiltration, or as a side effect from cancer treatment. Notably, stroke in cancer patients is associated with poor functional outcomes and reduced survival. Currently, however, there are no clear guidelines for antithrombotic management for prevention of recurrent strokes in these patients. Methods: We conducted a single-center retrospective chart review from 2013-2019. All adult patients with an ischemic stroke occurring with active malignancy and who then received either a direct oral anticoagulant (DOAC) or low molecular weight heparin (LMWH) were included. Patients with hemorrhagic stroke, an intracranial malignancy, or who were immediately admitted to hospice were excluded. Results: A total of 55 patients were included with a mean age of 71.8 years (range 28-96), 60% females, 87.3% first-time strokes, and 54.9% with metastatic disease. After stroke, 25 patients received a DOAC and 30 received LMWH for anticoagulation with a mean follow-up of 403 days. Between these two groups, most presentation and treatment characteristics were similar except for baseline hypertension, hyperlipidemia, additional initiation of an antiplatelet, and follow-up time. There was no difference in either stroke recurrence (DOAC vs LMWH: OR 2.61 [0.51-13.45], p=0.252) or time to recurrent stroke (DOAC vs LMWH: HR 1.68, p=0.446), but both analyses required adjustment for additional initiation of an antiplatelet—which was significantly protective regardless of anticoagulation choice (p=0.021* and p=0.017*, respectively). There was a trend towards improved survival if placed on a DOAC (HR 0.27, p=0.051), even after adjusting for metastatic disease. Conclusions: In this initial study of cancer patients with ischemic stroke, anticoagulation choice made no difference on stroke recurrence; however, addition of an antiplatelet agent was significantly protective. There was also a trend towards improved survival on a DOAC. Additional prospective data incorporating a larger sample size could further validate these findings.

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