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Clot-busting drugs after stroke given less to patients with cancer
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Patients with cancer are less likely to receive standard clot-busting medications in the event of acute ischemic stroke compared with patients without cancer, according to a presentation from the International Stroke Conference.
According to Babak B. Navi, MD, from Weill Cornell Medicine, and colleagues, approximately 10% of patients with ischemic stroke have comorbid cancer, and patients with cancer are typically excluded from acute ischemic stroke recanalization therapy trials.
To assess whether patients with cancer receive acute recanalization therapies as often as those without cancer among those with acute ischemic stroke, and to characterize temporal trends in stroke recanalization therapy in patients with and without cancer, Navi and colleagues conducted a retrospective cohort study using claims-based data from the National Inpatient Sample.
Using a validated ICD-9-CM diagnosis code algorithm, the researchers identified all patients hospitalized with acute ischemic stroke from 1998 to 2013.
The primary outcome of the study was use of IV tissue plasminogen activator (tPA), and the secondary outcome was use of endovascular therapy.
Of the 8.5 million patients with acute ischemic stroke, 5.2% had cancer, according to the researchers.
The study showed that the rate of IV tPA use among patients with acute ischemic stroke and cancer increased from 0.01% (95% CI, 0-0.02) in 1998 to 4.23% (95% CI, 3.72-4.75) in 2013; however, the rate of IV tPA use among patients with acute ischemic stroke without cancer increased from 0.02% (95% CI, 0.01-0.02) in 1998 to 6.38% (95% CI, 6.16-6.61) in 2013.
Patients with cancer were less likely to receive IV tPA than those without it (demographic-adjusted OR = 0.64; 95% CI, 0.61-0.68), according to the researchers.
The rate of endovascular therapy use among patients with acute ischemic stroke and cancer increased from 0.05% (95% CI, 0.02-0.07) in 2006 to 1.07% (95% CI, 0.81-1.33) in 2013, and rates of endovascular therapy use among patients with acute ischemic stroke without cancer increased from 0.09% (95% CI, 0-0.18) in 2006 to 1.09% (95% CI, 0.95-1.22) in 2013, according to Navi and colleagues.
The likelihood of receiving endovascular therapy was similar in both groups (demographic adjusted OR = 0.97; 95% CI, 0.86-1.09), the researchers found.
In a temporal trend analysis, the demographic-adjusted OR per year of receiving IV tPA and endovascular therapy was similar in both groups. Utilization of both therapies rose over time in both groups. – by Dave Quaile
Reference:
Navi B, et al. Abstract 161. Presented at: International Stroke Conference; Jan. 23-26, 2018; Los Angeles.
Disclosure: Navi reports that he receives research funding from NIH.