Post-Treatment Plasma D-Dimer Levels Are Associated With Short-Term Outcomes in Patients With Cancer-Associated Stroke

Sho Nakajima; Hiroyuki Kawano; Kazuo Yamashiro; Ryota Tanaka; Tomoaki Kameda; Naohide Kurita; Kenichiro Hira; Nobukazu Miyamoto; Yuji Ueno; Masao Watanabe; Teruyuki Hirano; Shigeru Fujimoto; Takao Urabe; Nobutaka Hattori

doi:10.3389/fneur.2022.868137

Post-Treatment Plasma D-Dimer Levels Are Associated With Short-Term Outcomes in Patients With Cancer-Associated Stroke

Front Neurol. 2022 Apr 4:13:868137. doi: 10.3389/fneur.2022.868137. eCollection 2022.

Authors

Sho Nakajima^{1

2}, Hiroyuki Kawano³, Kazuo Yamashiro^{1

2}, Ryota Tanaka⁴, Tomoaki Kameda⁵, Naohide Kurita^{1

2}, Kenichiro Hira¹, Nobukazu Miyamoto¹, Yuji Ueno¹, Masao Watanabe², Teruyuki Hirano³, Shigeru Fujimoto⁴, Takao Urabe², Nobutaka Hattori¹

Affiliations

¹ Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
² Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan.
³ Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan.
⁴ Division of Neurology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
⁵ Department of Neurology, Shin-Oyama City Hospital, Tochigi, Japan.

Abstract

Background and objective: Hypercoagulability is associated with increased risks of ischemic stroke and subsequent mortality in patients with active cancer. This study investigated the relationships between plasma D-dimer levels after stroke treatment and short-term outcomes in patients with cancer-associated stroke.

Methods: This retrospective, observational, multicenter study analyzed consecutive patients with cancer-associated ischemic stroke. Hypercoagulability was assessed by plasma D-dimer levels before and after stroke treatment. Short-term outcomes were assessed in terms of poor outcomes (a modified Rankin Scale score >3), cumulative rates of recurrent ischemic stroke, and mortality at 30 days after admission.

Results: Of 282 patients, 135 (47.9%) showed poor outcomes. Recurrent ischemic stroke was observed in 28 patients (9.9%), and the cumulative mortality rate was 12.4%. Multivariate analysis showed that post-treatment plasma D-dimer levels ≥10 μg/ml were independently associated with both poor outcomes (adjusted odds ratio [OR], 9.61; 95% confidence interval [CI], 3.60-25.70; P < 0.001) and mortality (adjusted OR, 9.38; 95% CI, 3.32-26.44; P < 0.001). Pre-treatment plasma D-dimer levels ≥10 μg/ml were not associated with these outcomes. Patients who received heparin had higher pre-treatment plasma D-dimer levels than those treated with other anticoagulants. Heparin produced a significant reduction in D-dimer levels from pre- to post-treatment without increasing the incidence of hemorrhagic events.

Conclusion: A high plasma D-dimer level after stroke treatment was associated with poor short-term outcomes in patients with cancer-associated stroke. Using anticoagulants to reduce D-dimer levels may improve short-term outcomes in these patients.

Keywords: D-dimer; anticoagulant; cancer; prognosis; stroke.