{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:31:10Z","timestamp":1792791070993,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Approximately 5\u201310% of patients with acute ischemic stroke (AIS) have known active cancer. These patients are at high risk for both recurrent AIS and major bleeding. The optimal antithrombotic strategy for cancer-related stroke is uncertain. This study compared clinical outcomes among patients with cancer-related stroke treated with anticoagulant versus antiplatelet therapy for secondary prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified consecutive patients with AIS and active cancer hospitalized at our comprehensive stroke center from 2015 through 2020. Patients with cardioembolic mechanisms were excluded. We used Cox regression and inverse probability of treatment weighting (IPTW) analyses to evaluate the associations between type of antithrombotic therapy at discharge (anticoagulant versus antiplatelet therapy) and the main outcomes of 1-year mortality and long-term recurrent AIS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 5,012 AIS patients, 306 had active cancer. After applying study eligibility criteria, we analyzed 135 patients (median age 72\u202fyears; 44% women), of whom 58 (43%) were treated with anticoagulant and 77 (57%) with antiplatelet therapy. The median follow-up time was 495\u202fdays (IQR, 57\u20131,029). Patients treated with anticoagulants, compared to patients treated with antiplatelet therapy, were younger (median 69 versus 75\u202fyears), had more metastatic disease (72% versus 41%), and higher median baseline D-dimer levels (median 8,536\u202f\u03bcg\/L versus 1,010\u202f\u03bcg\/L). Anticoagulant versus antiplatelet therapy was associated with similar risks of 1-year mortality (adjusted hazard ratio [aHR], 0.76; 95% confidence interval [CI], 0.36\u20131.63) and long-term recurrent AIS (aHR 0.49; 95% CI 0.08\u20132.83). The IPTW analyses for 1-year mortality confirmed the results of the main analyses (HR 0.82; 95%CI: 0.39\u20131.72, <jats:italic>p<\/jats:italic>\u202f=\u202f0.61).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Factors associated with anticoagulant use in patients with cancer-related stroke include younger age, more advanced cancer, and elevated D-dimer. Similar outcomes were seen with anticoagulant versus antiplatelet therapy in these patients highlighting the need for future randomized trials to determine the preferred antithrombotic strategy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1530775","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T04:11:59Z","timestamp":1757995919000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Anticoagulant versus antiplatelet treatment for secondary stroke prevention in patients with active cancer"],"prefix":"10.3389","volume":"16","author":[{"given":"Moritz C.","family":"Kielkopf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayan","family":"G\u00f6cmen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selina B.","family":"Venzin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Steinauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Branca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Boronylo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina B.","family":"G\u00f6ldlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Kaesmacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Mujanovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Costamagna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"Meinel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Seiffge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"B\u00fccke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam R.","family":"Heldner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava L.","family":"Liberman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hooman","family":"Kamel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Pabst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin D.","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Scutelnic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babak B.","family":"Navi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morin","family":"Beyeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/17562864221106362","article-title":"Cancer and stroke: commonly encountered by clinicians, but little evidence to guide clinical approach","volume":"15","author":"Woock","year":"2022","journal-title":"Ther Adv Neurol Disord"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1016\/j.jstrokecerebrovasdis.2012.11.016","article-title":"Trends in cancer diagnoses among inpatients hospitalized with stroke","volume":"22","author":"Sanossian","year":"2013","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1002\/ana.25227","article-title":"Ischemic stroke in cancer patients: a review of an underappreciated pathology","volume":"83","author":"Navi","year":"2018","journal-title":"Ann Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1042\/BSR20130057","article-title":"Activation of blood coagulation in cancer: implications for tumour progression","volume":"33","author":"Lima","year":"2013","journal-title":"Biosci Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"779","DOI":"10.3892\/ijo.2019.4669","article-title":"Cancer-associated stroke: pathophysiology, detection and management (review)","volume":"54","author":"Dardiotis","year":"2019","journal-title":"Int J Oncol"},{"key":"ref6","first-page":"e364","volume-title":"Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association\/American Stroke Association","author":"Kleindorfer","year":"2021"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"144","DOI":"10.4103\/tcmj.tcmj_55_19","article-title":"Anticoagulants for cancer-associated ischemic stroke","volume":"31","author":"Hsu","year":"2019","journal-title":"Tzu Chi Med J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"77","DOI":"10.5853\/jos.2016.00570","article-title":"Hypercoagulability and mortality of patients with stroke and active cancer: the OASIS-CANCER study","volume":"19","author":"Lee","year":"2017","journal-title":"J Stroke"},{"key":"ref9","first-page":"958","article-title":"Apixaban vs aspirin in patients with cancer and cryptogenic stroke a post hoc analysis of the ARCADIA randomized clinical trial","volume-title":"JAMA Neurol","author":"Navi","year":"2024"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1111\/ene.14172","article-title":"Rivaroxaban versus aspirin for secondary prevention of ischaemic stroke in patients with cancer: a subgroup analysis of the NAVIGATE ESUS randomized trial","volume":"27","author":"Martinez-Majander","year":"2020","journal-title":"Eur J Neurol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1111\/jth.14219","article-title":"Role of direct oral anticoagulants in the treatment of cancer-associated venous thromboembolism: guidance from the SSC of the ISTH","volume":"16","author":"Khorana","year":"2018","journal-title":"J Thromb Haemost"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106609","article-title":"Development of a score for prediction of occult malignancy in stroke patients (occult-5 score)","volume":"31","author":"Beyeler","year":"2022","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1177\/1747493020971104","article-title":"Frequency and predictors of occult cancer in ischemic stroke: a systematic review and meta-analysis","volume":"16","author":"Rioux","year":"2021","journal-title":"Int J Stroke"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fneur.2023.1148152","article-title":"Absence of susceptibility vessel sign and hyperdense vessel sign in patients with cancer-related stroke","volume":"14","author":"Beyeler","year":"2023","journal-title":"Front Neurol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/ene.16200","article-title":"Acute ischaemic stroke in active cancer versus non-cancer patients: stroke characteristics, mechanisms and clinical outcomes","volume":"31","author":"Costamagna","year":"2024","journal-title":"Eur J Neurol"},{"key":"ref16","volume-title":"TNM classification","author":"Rosen","year":"2023"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/S1474-4422(13)70310-7","article-title":"Embolic strokes of undetermined source: the case for a new clinical construct","volume":"13","author":"Hart","year":"2014","journal-title":"Lancet Neurol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.str.24.1.35","article-title":"Classification of subtype of acute ischemic stroke","volume":"24","author":"Adams","year":"1993","journal-title":"Stroke"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1177\/17474930241260589","article-title":"Prevalence of right-to-left shunt in stroke patients with cancer","volume":"19","author":"Steinauer","year":"2024","journal-title":"Int J Stroke"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"164","DOI":"10.5853\/jos.2023.03279","article-title":"Cancer-associated stroke: thrombosis mechanism, diagnosis, outcome, and therapeutic strategies","volume":"26","author":"Heo","year":"2024","journal-title":"J Stroke"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1001\/jamaneurol.2017.4211","article-title":"Enoxaparin vs aspirin in patients with cancer and ischemic stroke: the TEACH pilot randomized clinical trial","volume":"75","author":"Navi","year":"2018","journal-title":"JAMA Neurol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1056\/NEJMoa0804656","article-title":"Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke","volume":"359","author":"Hacke","year":"2008","journal-title":"N Engl J Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2101","DOI":"10.1161\/01.STR.30.10.2101","article-title":"Changes in coagulation and fibrinolysis markers in acute ischemic stroke treated with recombinant tissue plasminogen activator","volume":"30","author":"Fassbender","year":"1999","journal-title":"Stroke"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"457","DOI":"10.2188\/jea.JE20210145","article-title":"Using propensity scores for causal inference: pitfalls and tips","volume":"31","author":"Shiba","year":"2021","journal-title":"J Epidemiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e8","DOI":"10.1002\/onco.13584","article-title":"Treatment of cancer-associated venous thromboembolism with low-molecular-weight heparin or direct oral anticoagulants: patient selection, controversies, and caveats","volume":"26","author":"O\u2019Connell","year":"2021","journal-title":"Oncologist"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e2738","DOI":"10.1002\/brb3.2738","article-title":"Cancer-related stroke: exploring personalized therapy strategies","volume":"12","author":"Chen","year":"2022","journal-title":"Brain Behav"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.3174\/ajnr.A4846","article-title":"Three-territory DWI acute infarcts: diagnostic value in cancer-associated hypercoagulation stroke (trousseau syndrome)","volume":"37","author":"Finelli","year":"2016","journal-title":"Am J Neuroradiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1002\/ana.22050","article-title":"Coagulopathy and embolic signal in cancer patients with ischemic stroke","volume":"68","author":"Seok","year":"2010","journal-title":"Ann Neurol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1002\/ana.26129","article-title":"Mechanisms of ischemic stroke in patients with cancer: a prospective study","volume":"90","author":"Navi","year":"2021","journal-title":"Ann Neurol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2046","DOI":"10.1111\/jth.15779","article-title":"Ischemic stroke with cancer: hematologic and embolic biomarkers and clinical outcomes","volume":"20","author":"Navi","year":"2022","journal-title":"J Thromb Haemost"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"CD000187","DOI":"10.1002\/14651858.CD000187.pub2","article-title":"Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack","volume":"2004","author":"Saxena","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.3390\/jcm8091457","article-title":"Baseline D-dimer levels as a risk assessment biomarker for recurrent stroke in patients with combined atrial fibrillation and atherosclerosis","volume":"8","author":"Choi","year":"2019","journal-title":"J Clin Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.05.031","article-title":"Recurrent thromboembolic events after ischemic stroke in patients with cancer","volume":"83","author":"Parikh","year":"2014","journal-title":"Neurology"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1093\/ckj\/sfab158","article-title":"An introduction to inverse probability of treatment weighting in observational research","volume":"15","author":"Chesnaye","year":"2022","journal-title":"Clin Kidney J"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1530775\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T04:12:00Z","timestamp":1757995920000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1530775\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,16]]},"references-count":34,"alternative-id":["10.3389\/fneur.2025.1530775"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1530775","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,16]]},"article-number":"1530775"}}