PMID- 34454242
OWN - NLM
STAT- MEDLINE
DCOM- 20211015
LR  - 20211015
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 206
DP  - 2021 Oct
TI  - Therapeutic efficacy of heparin and direct factor Xa inhibitors in 
      cancer-associated cryptogenic ischemic stroke with venous thromboembolism.
PG  - 99-103
LID - S0049-3848(21)00434-5 [pii]
LID - 10.1016/j.thromres.2021.08.016 [doi]
AB  - BACKGROUND: Anticoagulation therapy, especially using heparin or recently 
      developed oral direct factor Xa inhibitors (DiXals), is recommended as first-line 
      treatment for cancer-related venous thromboembolism (VTE). However, the 
      preventive efficacy of these anticoagulants for cancer-associated ischemic stroke 
      is still unknown. We retrospectively investigated the efficacy of subcutaneous 
      unfractionated heparin (UFH) and DiXals for preventing the recurrence of 
      cancer-associated cryptogenic ischemic stroke with VTE. METHODS: We 
      retrospectively studied consecutive patients with cancer-associated cryptogenic 
      ischemic stroke and comorbid VTE who received subcutaneous UFH or oral DiXaIs at 
      9 hospitals. RESULT: Fifty-three patients (24 treated with UFH and 29 treated 
      with DiXaIs) were enrolled. Of these, 47 demonstrated systemic metastasis (cancer 
      stage IV). During 30-day follow-up after initiation of anticoagulation therapy, 
      recurrent ischemic stroke was observed in only 1 patient (4%) in the UFH group 
      and in 9 patients (31%) in the DiXal group. The incidence of major bleeding 
      complications was similar between the 2 groups (4% and 10%, respectively). The 
      cumulative risk of ischemic stroke recurrence within 30 days was lower with UFH 
      than with DiXals (competing risk analysis, p = 0.008). In the DiXal group, 
      patients who experienced recurrence showed significantly higher D-dimer levels 
      than those without recurrence. CONCLUSION: In patients with cancer-associated 
      cryptogenic ischemic stroke and comorbid VTE, UFH demonstrated a lower rate of 
      recurrent ischemic stroke than DiXaIs, and there were no differences in bleeding 
      risk between the 2 treatments. D-dimer levels at stroke onset increased the risk 
      of recurrence in the DiXal group but not in the UFH group.
CI  - Copyright (c) 2021 Elsevier Ltd. All rights reserved.
FAU - Yamaura, Genpei
AU  - Yamaura G
AD  - Department of Neurology, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa 
      251-8550, Japan.
FAU - Ito, Takeshi
AU  - Ito T
AD  - Department of Neurology, Yokohama Municipal Citizen's Hospital, 1-1 
      Mitsuzawanishimachi, Kanagawa-ku, Yokohama 221-0855, Japan.
FAU - Miyaji, Yosuke
AU  - Miyaji Y
AD  - Department of Neurology and Stroke Medicine, Yokohama City University Graduate 
      School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
FAU - Ueda, Naohisa
AU  - Ueda N
AD  - Department of Neurology, Yokohama City University Medical Center, 4-57 
      Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
FAU - Nakae, Yoshiharu
AU  - Nakae Y
AD  - Department of Neurology, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10 Konandai, 
      Konan-ku, Yokohama 234-0054, Japan.
FAU - Momoo, Takayuki
AU  - Momoo T
AD  - Department of Neurology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka 
      254-8502, Japan.
FAU - Nakano, Tatsu
AU  - Nakano T
AD  - Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, 132 
      Katsura-cho, Sakae-ku, Yokohama 247-8581, Japan.
FAU - Johmura, Yuji
AU  - Johmura Y
AD  - Department of Neurology, Yokohama Minami Kyousai Hospital, 1-21-1 
      Mutsuurahigashi, Kanazawa-ku, Yokohama 236-0037, Japan.
FAU - Higashiyama, Yuichi
AU  - Higashiyama Y
AD  - Department of Neurology and Stroke Medicine, Yokohama City University Graduate 
      School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
FAU - Joki, Hideto
AU  - Joki H
AD  - Department of Neurology and Stroke Medicine, Yokohama City University Graduate 
      School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
FAU - Doi, Hiroshi
AU  - Doi H
AD  - Department of Neurology and Stroke Medicine, Yokohama City University Graduate 
      School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
FAU - Takeuchi, Hideyuki
AU  - Takeuchi H
AD  - Department of Neurology and Stroke Medicine, Yokohama City University Graduate 
      School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
FAU - Takahashi, Tatsuya
AU  - Takahashi T
AD  - Department of Neurology, National Hospital Organization Yokohama Medical Center, 
      3-60-2 Harajuku, Totsuka-ku, Yokohama 245-8575, Japan.
FAU - Koyano, Shigeru
AU  - Koyano S
AD  - Department of Neurology, Yokohama Minami Kyousai Hospital, 1-21-1 
      Mutsuurahigashi, Kanazawa-ku, Yokohama 236-0037, Japan.
FAU - Yamaguchi, Shigeki
AU  - Yamaguchi S
AD  - Department of Neurology, Yokohama Municipal Citizen's Hospital, 1-1 
      Mitsuzawanishimachi, Kanagawa-ku, Yokohama 221-0855, Japan.
FAU - Yokoyama, Mutsumi
AU  - Yokoyama M
AD  - Department of Neurology, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa 
      251-8550, Japan.
FAU - Tanaka, Fumiaki
AU  - Tanaka F
AD  - Department of Neurology and Stroke Medicine, Yokohama City University Graduate 
      School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. 
      Electronic address: ftanaka@yokohama-cu.ac.jp.
LA  - eng
PT  - Journal Article
DEP - 20210823
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Factor Xa Inhibitors)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - *Brain Ischemia/complications/drug therapy
MH  - Factor Xa Inhibitors/therapeutic use
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight
MH  - Humans
MH  - *Ischemic Stroke
MH  - *Neoplasms/complications
MH  - Retrospective Studies
MH  - *Stroke/drug therapy/etiology
MH  - *Venous Thromboembolism/drug therapy/etiology
OTO - NOTNLM
OT  - Cancer
OT  - Cryptogenic ischemic stroke
OT  - Direct factor Xa inhibitor
OT  - Heparin
OT  - Venous thromboembolism
EDAT- 2021/08/29 06:00
MHDA- 2021/10/16 06:00
CRDT- 2021/08/28 20:17
PHST- 2021/04/24 00:00 [received]
PHST- 2021/08/17 00:00 [revised]
PHST- 2021/08/18 00:00 [accepted]
PHST- 2021/08/29 06:00 [pubmed]
PHST- 2021/10/16 06:00 [medline]
PHST- 2021/08/28 20:17 [entrez]
AID - S0049-3848(21)00434-5 [pii]
AID - 10.1016/j.thromres.2021.08.016 [doi]
PST - ppublish
SO  - Thromb Res. 2021 Oct;206:99-103. doi: 10.1016/j.thromres.2021.08.016. Epub 2021 
      Aug 23.