Stroke in cancer patients: a risk factor analysis

Background and Purpose In patients already suffering from cancer, the additional occurrence of stroke can aggravate the burden of the disease. The purpose of this study was to compare risk factors for haemorrhagic and ischemic strokes in cancer and non-cancer patients. Methods A retrospective analysis, including 1,274 stroke patients admitted to a stroke unit, was conducted from 2004 to 2007. Classical risk factors for stroke and clinical outcome measures were compared between cancer and non-cancer patients. Results Twelve percent of stroke patients had an additional diagnosis of cancer. In the non-cancer population, 84% had ischemic and 16% had haemorrhagic strokes. In cancer patients, 86% had ischemic and 14% had haemorrhagic strokes. Vascular risk factors in cancer patients, including hypertension, atrial fibrillation, coronary vessel disease, smoking, hypercholesterolemia and diabetes mellitus, showed no difference compared to the non-cancer population. Only thrombotic events occurred more often in the cancer cohort. The most frequent cancer types were urogenital, breast and gastrointestinal. Regarding clinical outcome, cancer patients had an inferior neurological condition at discharge and a trend towards a longer stay in the stroke unit. Conclusions The frequency of ischemic and haemorrhagic stroke in tumour patients is similar to that in the non-cancer population. Cerebrovascular risk factors do not significantly vary between cancer and non-cancer patients. The higher frequency of thrombotic events in cancer patients may reflect a coagulation disorder, commonly found in patients with malignancy. Clinical outcome in cancer patients may be worsened by the pre-existent co-morbidity.