Abstract TP415: Anticoagulation Therapy in Patients With Cancer Related Stroke and High Risk of Bleeding

Abstract

Introduction: Treatment of cancer related ischemic stroke is challenging because they are at increased risk of both bleeding and thrombosis recur. In general, low-molecular weight heparin is recommended to treat cancer related stroke. However, it is uncertain whether anticoagulation is safe and effective in patients at high risk of bleeding such as thrombocytopenia. We compared the clinical outcomes according to anticoagulant therapy in these patients. Methods: We recruited consecutive patients with cancer related stroke between January 2014 and July 2018. Cancer related ischemic stroke was defined as cryptogenic embolic infarction in patients with active systemic cancer and elevated D-dimer level. We included only patient with increased bleeding risk (platelet < 1000000/ul or Hb <8 or active bleeding evidence) in this study. Patients were classified into 3 groups according to the treatment of anticoagulants: those who received full dose anticoagulants; low doses; no anticoagulants. This study outcomes included 7 days bleeding or thrombosis event. Results: A total of 48 patients were included in the analysis. Twelve patients received full dose anticoagulation, 21 received low dose anticoagulants, and 8 received no anticoagulants. There were 8 thrombosis events (2 ischemic stroke and 6 deep vein thrombosis) for 7 days. Thrombosis occurred in a statistically significant number of patients who were not treated with anticoagulation, compared to patients who received anticoagulant (vs. full dose group, P=0.032; vs. low dose group, P=0.048). There was no difference in the incidence of thrombosis according to the dose of anticoagulant (P=0.091). Eight bleeding events occurred and there was no intracranial hemorrhage (Gastrointestinal bleeding 3; Hemoptysis 3; Vaginal bleeding 1; Hematuria 1). They were not life-threatening bleeding. The difference in frequency of bleeding in each group was not statistically significant (P=0.068). Conclusions: Anticoagulant therapy may be more beneficial than risk, even in patients at risk for bleeding to treat cancer related stroke. Larger, prospective trials are required to determine the appropriate dose of anticoagulant and to further evaluate safety of anticoagulation in this patient population.