Incidence and risk factors for recurrent venous thromboembolism, recurrent stroke and bleeding in Chinese patients with acute ischemic stroke and cancer : a real-world study

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BACKGROUND: Patients with acute ischemic stroke (AIS) and cancer are at exceptionally high risk for recurrent thromboembolism (RTE), which includes venous thromboembolism (VTE) and arterial thromboembolism (ATE). Yet contemporary data from Chinese patients remain scarce. METHODS: In this retrospective, observational study conducted at Tianjin First Central Hospital (June 2023-December 2024), consecutive adults with AIS and cancer were enrolled. The primary outcomes during 6 months follow-up were recurrent VTE།composite VTE (symptomatic and incidental VTE requiring treatment), recurrent stroke [cerebral infarction, transient ischemic attack (TIA), and systemic embolism (SE)], and bleeding (major bleeding and clinically significant non-major bleeding). Multivariable logistic regression was used to identify independent predictors of each endpoint. RESULTS: Among 218 eligible patients, 49 (22.5%) had baseline VTE, of whom 45 (91.8%) were asymptomatic. Baseline VTE was independently predicted by cryptogenic stroke subtype (OR 2.70; 95% CI 1.101-6.621; P = 0.030) and D-dimer > 1.2 µg/mL (OR 3.619; 95% CI 1.505-8.703; P = 0.004). During follow-up, 25 patients (11.5%) experienced composite VTE, 71 patients (32.6%) experienced recurrent stroke, and 21 patients (9.6%) experienced bleeding. Multivariable analysis revealed that D-dimer > 1.2 µg/mL independently predicted recurrent VTE (OR 3.501; 95% CI 1.012-12.112; P = 0.048), whereas cancer metastasis portended recurrent stroke (OR 3.155; 95% CI 1.423-6.995; P = 0.005), and anticoagulant therapy was associated with an increased bleeding risk (OR 9.458; 95% CI 1.158-77.267; P = 0.036). CONCLUSIONS: In this Chinese cohort of patients with acute ischemic stroke (AIS) and cancer, routine screening revealed venous thromboembolism (VTE) in roughly one-fifth of participants at baseline, most of whom were asymptomatic. Exploratory multivariable analyses indicated that cryptogenic stroke subtype and D-dimer > 1.2 µg/mL were associated with prevalent VTE, while D-dimer > 1.2 µg/mL also predicted recurrent VTE. These findings suggested that D-dimer guided VTE screening might be considered at the time of stroke presentation, even in the absence of symptoms. Cancer metastasis showed an association with recurrent stroke, whereas anticoagulant therapy was linked to a higher bleeding risk.

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