SHOULD CEREBRAL ISCHEMIC EVENTS IN CANCER-PATIENTS BE CONSIDERED A MANIFESTATION OF HYPERCOAGULABILITY

Background and Purpose Previous studies, mainly autopsy-based, suggest that the spectrum of stroke in cancer patients differs from that of t he general population. These studies also suggest that cerebrovascular events frequently are a manifestation of hypercoagulability. However, no studies that address this question in the adult oncological popula tion from a clinical perspective are available. We therefore assessed the clinical impact of cerebral ischemic events in cancer patients and attempted to determine whether their occurrence represents a manifest ation of Trousseau's syndrome. Methods A computerized database that re cords an neurological admissions and consultations at a tertiary medic al center was used to retrospectively identify all patients with cereb ral ischemic events and cancer. Results Thirty-three patients represen ting 3.5% of all stroke consultations and admissions seen at the Unive rsity of Massachusetts Medical Center were identified during the perio d 1988 through 1992. Large-vessel atherosclerosis was the most frequen t cause of stroke. Furthermore, although 30% were determined to have h ypercoagulability as a cause using clinical criteria, in only one of n ine patients in whom tests were done was sufficient evidence present t o make a presumptive diagnosis of disseminated intravascular coagulati on. Irrespective of therapy, recurrent cerebral ischemic events were n oted in only 6% of patients during a follow-up period averaging greate r than 9 months, a figure that is similar to that for the risk of repe ated events in the noncancer population. Conclusions Recognizing the l imitations of this retrospective study, it appears nonetheless that co nventional stroke origins account for the majority of cerebral ischemi c events in the adult cancer population Although hypercoagulability is present to a greater extent than in the nononcological population, re current strokes seem to occur no more frequently than in the nononcolo gical population, and antiplatelet agents seem sufficient therapy for most patients.