Anticoagulants for cancer-associated ischemic stroke.

Jin-Yi Hsu, An-Bang Liu
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Abstract

Patients with cancer-associated ischemic stroke pose similar clinical manifestations and image characteristics, mainly embolic infarction, as patients with atrial fibrillation do. D-dimer, a degraded product of fibrin polymer, is a useful indicator of hypercoagulability, which frequently increases in cancer-associated stroke, but not in stroke resulted from atrial fibrillation. The level of serum D-dimer is associated with mortality, prognosis, and recurrence of systemic thromboembolism in these patients. Theoretically, drugs block coagulation cascade, such as heparin and low-molecular-weight-heparin (LMWH), oral direct anticoagulants, could attenuate the status of hypercoagulation and decrease the amount of D-dimer. These drugs may be helpful to prevent thromboembolic events in patients with cancer-associated hypercoagulability. Vitamin K antagonist, warfarin, decreases the production of coagulation factors, but not interrupts coagulation cascade may not be helpful to decrease hypercoagulability, but increase the risk of bleeding. However, the treatment of cancer-associated embolic stroke is still controversial. This article reviews relevant clinical studies and proposes the applicability of direct oral anticoagulants from the pathophysiological mechanism.

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抗凝剂治疗癌症相关缺血性中风。
癌症相关缺血性中风患者的临床表现和影像特征与心房颤动患者相似,主要是栓塞性梗死。D-二聚体是纤维蛋白聚合物的降解产物,是高凝状态的有效指标,在癌症相关性卒中中经常增加,但在心房颤动导致的卒中中却没有增加。血清 D-二聚体水平与这些患者的死亡率、预后和全身血栓栓塞复发有关。从理论上讲,阻断凝血级联的药物,如肝素和低分子量肝素(LMWH)等口服直接抗凝剂,可减轻高凝状态并降低 D-二聚体的含量。这些药物可能有助于预防癌症相关高凝状态患者的血栓栓塞事件。维生素 K 拮抗剂华法林可减少凝血因子的产生,但不能中断凝血级联,可能无助于降低高凝状态,反而会增加出血风险。然而,癌症相关栓塞性卒中的治疗仍存在争议。本文回顾了相关临床研究,并从病理生理机制出发,提出了直接口服抗凝药的适用性。
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