Cancer-Associated Coagulopathy–Related Stroke

A systematic review of 82 studies found that stroke related to cancer-associated coagulopathy (CAC) is a distinct, often underrecognized condition characterized by early occurrence, frequent recurrence, characteristic imaging findings, and high mortality. CAC-related stroke occurs predominantly within six months of cancer diagnosis and is strongly associated with advanced or metastatic cancer, particularly adenocarcinomas such as lung and pancreatic cancer. Proposed mechanisms include mucin-mediated platelet aggregation, tissue factor–driven coagulation, extracellular vesicles, and neutrophil extracellular trap formation, resulting in thromboinflammation and platelet-rich thrombi. D-dimer is the most consistently biomarker associated with recurrent stroke and mortality, whereas C-reactive protein, fibrinogen, CA-125, and transcranial Doppler microembolic signals have limited specificity. Imaging often reveals multiple infarcts involving more than two vascular territories, with the “three territories sign” being particularly characteristic. Low-molecular-weight heparin and direct oral anticoagulants are the most commonly used strategies for secondary prevention, but 30-day mortality remains high at 25%–50%. Earlier recognition and optimization of antithrombotic treatment may help improve outcomes. Source: https://link.springer.com/