Advanced cancer mediates elevated stroke risk after chemo

  • Kitano T & al.
  • Thromb Haemost
  • 1 Apr 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Among oncology patients, chemotherapy is not a significant risk factor for stroke after adjustment for cancer site and stage.

Why this matters

  • Better understanding of chemotherapy-related stroke risk could inform targeted intervention.

Key results

  • 31% of the cohort had chemotherapy listed in the initial treatment plan.
  • By type:
    • 91% cytotoxic agents,
    • 14% monoclonal antibodies, and
    • 5.8% tyrosine kinase inhibitors.
  • Stroke incidence within 2 years of diagnosis:
    • 0.75% with chemotherapy and
    • 0.39% without chemotherapy.
  • Stroke risk with vs without chemotherapy (HRs; 95% CIs):
    • In Kaplan-Meier analysis: 1.84 (1.23-2.75).
    • After adjustment for cancer site, extent (advanced vs nonadvanced): 1.20 (0.76-1.91).
    • In stratified Cox regression model: 1.26 (0.78-2.03).
  • Findings similar for patients confirmed to receive chemotherapy, for platinum-based chemotherapy alone.

Study design

  • Japanese retrospective cohort study using hospital-based cancer registry data for 2007-2015.
  • 19,006 adult patients with cancer at any site (12.9% breast; 10.9% uterine; 8.9% gastric; 7.8% prostate; 7.8% colorectal; 7.3% lung), any stage.
  • Main outcome: stroke.
  • Funding: Kakenhi (Grants-in-Aid for Scientific Research) of the Japan Society for the Promotion of Science.

Limitations

  • Analyses only for chemotherapy overall, platinum agents.
  • Duration of risk elevation unclear.
  • Possible misclassification.
  • Potential unmeasured confounding.
  • Unknown generalizability.