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J Neurooncol. 2016 Jun;128(2):277-84. doi: 10.1007/s11060-016-2106-0. Epub 2016 Mar 11.

Predictors of survival for patients with cancer after cryptogenic stroke.

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Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Nohwa Branch of Public Health Center, Seoul, Jeollanam-do, South Korea.
Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Integrated Cancer Care Center, Seoul National University Cancer Hospital, Seoul, South Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, South Korea.
Department of Radiology, Seoul National University Hospital, Seoul, South Korea.


Patients with active cancer experience ischemic stroke via cryptogenic mechanisms, with cancer-associated hypercoagulability being considered a major contributor to such strokes. Despite the remarkably shortened survival of these patients, the clinical predictors of survival are poorly understood. We determined the clinical factors including D-dimer levels serving as the predictors of overall survival in these patients. Retrospective study was conducted on cancer patients who visited our hospital for acute ischemic stroke with cryptogenic mechanisms from April 2012 through November 2014. Demographics, clinical characteristics, imaging and laboratory results including coagulation markers were collected, and overall survival was calculated from the patient medical records and a governmental national database. A high D-dimer level was defined as a D-dimer level exceeding the median value from the study population (>5.50 μg/ml). A total of 93 patients were identified, with a median survival of 62 days (interquartile range 32-223 days). A high D-dimer level (p = 0.004; hazard ratio [HR] 2.01, 95 % confidence interval [CI] 1.26-3.21), systemic metastases (p = 0.02; HR 2.08, 95 % CI 1.11-3.90), and diabetes mellitus (p = 0.03; HR 1.78, 95 % CI 1.03-3.10) were identified as independent predictors of poor overall survival using multivariate Cox proportional hazard analysis. Most of the patients (87 %) were primarily treated with low-molecular-weight heparin (dalteparin, n = 49; enoxaparin, n = 32). The type of low-molecular-weight heparin had no association with survival. A high D-dimer level, systemic metastases, and diabetes are independent predictors of poor survival in cancer patients with cryptogenic stroke.


Cryptogenic stroke; D-dimer; Predictor; Survival

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