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Cancer-associated coagulopathy (CAC) is an important mechanism of ischemic stroke in this population. We systematically reviewed the epidemiological, clinical, radiological, and pathophysiological features of CAC-related stroke, as well as associated biomarkers and treatment strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of PubMed\/MEDLINE, Scopus, Cochrane Library, and Embase (2000\u20132025) was performed according to PRISMA 2020 guidelines. Search terms included \u201cstroke\u201d, \u201ccancer\u201d, \u201chypercoagulability\u201d, \u201ccoagulopathy\u201d, \u201cdisseminated intravascular coagulation\u201d, and \u201cnon-bacterial or marantic thrombotic endocarditis\u201d. Studies published in English or Spanish were included, whereas case reports and review articles were excluded. Data were synthesized qualitatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-two studies met inclusion criteria. CAC-related stroke occurs predominantly within six months of cancer diagnosis and is strongly associated with advanced or metastatic disease and a high risk of early recurrence. Adenocarcinoma, particularly lung and pancreatic cancer, is the most frequently associated histological subtype. Proposed mechanisms include mucin-mediated platelet aggregation, tissue factor-driven coagulation, extracellular vesicles, and neutrophil extracellular trap formation, leading to thromboinflammation and platelet-rich thrombi. D-dimer is the biomarker most consistently associated with recurrence and mortality, while C-reactive protein, fibrinogen, CA-125, and transcranial Doppler microembolic signals show limited specificity. Characteristic imaging findings include multiple infarcts involving more than two vascular territories, particularly the \u2018three territories sign\u2019. Low-molecular-weight heparin and direct oral anticoagulants are the most commonly used secondary prevention strategies. Thirty-day mortality rates range from 25 to 50%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CAC-related stroke is a distinct and underrecognized entity characterized by specific biological and radiological features and poor outcomes. Earlier recognition and optimized antithrombotic strategies may improve prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14119-y","type":"journal-article","created":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T07:06:57Z","timestamp":1789888017000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stroke secondary to cancer-associated coagulopathy: a systematic review"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7963-5169","authenticated-orcid":false,"given":"Carlota","family":"Jauregui Larra\u00f1aga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"G\u00f3mez Arteta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Marta Enguita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Elena","family":"Erro Aguirre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"issue":"6","key":"14119_CR1","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1111\/j.1600-0404.2006.00709.x","volume":"114","author":"YY Zhang","year":"2006","unstructured":"Zhang YY, Chan DKY, Cordato D et al (2006) Stroke risk factor, pattern and outcome in patients with cancer. 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