Skip to main content
SpringerLink
Log in

Platelet count is associated with outcome in cancer patients with stroke

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Introduction

Cerebrovascular disease (CVD) and cancer are among the most common causes of mortality worldwide, preceded only by ischemic heart disease (IHD). Thrombocytopenia was shown to be associated with poor outcomes in IHD and CVD in the general population. This study aimed to assess the relationship of thrombocytopenia with poor outcomes in cancer patients with CVD.

Materials and methods

Data on patients with concomitant CVD and cancer who were initially treated at a cancer referral center between January 2010 and December 2017 were included. Thrombocytopenia was defined as a platelet count < 150,000/mm3 during the first 24 h of CVD symptom onset. The IRB (CI/837/17) approved the review of clinical records.

Results

Among 268 cancer patients with CVD included in the study, 210 met the inclusion criteria. Median overall survival of the entire cohort was 7.2 months, which was significantly shorter in males (p = 0.029) and patients with hematologic tumors (p = 0.009), hemorrhagic CVD (p < 0.001), altered mental status (p < 0.001), and thrombocytopenia (p < 0.001). Multiple regression logistic analysis revealed that thrombocytopenia (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1–2.4) and altered mental status (RR 2.7, 95% CI 1.9–4.0) remained statistically significant risk factors for mortality.

Conclusion

In cancer patients with CVD, thrombocytopenia at the time of CVD diagnosis and altered mental status during initial clinical evaluation were associated with higher mortality, which should be confirmed in future studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hankey GJ (2017) Stroke. The Lancet 389(10069):641–654. https://doi.org/10.1016/S0140-6736(16)30962-X

    Article  Google Scholar 

  2. GBD 2015 Mortality and causes of death collaborators (2016) Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet 388(10053):1459–1544. https://doi.org/10.1016/S0140-6736(16)31012-1

    Article  Google Scholar 

  3. Sinkovic A, Majal M (2015) The impact of thrombocytopenia on outcome in patients with acute coronary syndromes: a single center retrospective study. Biomed Res Int. https://doi.org/10.1155/2015/907304

    Article  PubMed  PubMed Central  Google Scholar 

  4. McClure MW, Berkowitz SD, Sparapani R et al (1999) Clinical significance of thrombocytopenia during a non-ST-elevation acute coronary syndrome. The platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy (PURSUIT) trial experience. Circulation 99(22):2892–2900. https://doi.org/10.1161/01.CIR.99.22.2892

    Article  CAS  PubMed  Google Scholar 

  5. Caixeta A, Dangas G-D, Mehran R et al (2011) Incidence and clinical consequences of acquired thrombocytopenia after antithrombotic therapies in patients with acute coronary syndromes: results from the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Am Heart J 161(2):298–306.e1. https://doi.org/10.1016/j.ahj.2010.10.035

    Article  PubMed  Google Scholar 

  6. Vora AN, Chenier M, Schulte PPJ et al (2014) Long-term outcomes associated with hospital acquired thrombocytopenia among patients with non-ST-segment elevation acute coronary syndrome. Am Heart J 168(2):189–196. https://doi.org/10.1016/j.ahj.2014.04.010

    Article  PubMed  Google Scholar 

  7. Ayoub Karab O, Gbolahan M, Meera et al (2018) Impact of baseline thrombocytopenia on in-hospital outcomes after percutaneous coronary interventions: analysis over 70,000 patients. JACC 71(11:10–12):A1164

    Article  Google Scholar 

  8. Liu Shuai S, Chenxi Z, Yanyan et al (2018) The impact of acquired thrombocytopenia on long-term outcomes of patients undergoing elective percutaneous coronary intervention: an analysis of 8,271 consecutive patients. Catheter Cardiovasc Interv 91(1):558–565. https://doi.org/10.1002/ccd.27498

    Article  CAS  PubMed  Google Scholar 

  9. Furlan JC, Fang J, Silver FL (2016) Outcomes after acute ischemic stroke in patients with thrombocytopenia or thrombocytosis. J Neurol Sci 362:198–203. https://doi.org/10.1016/j.jns.2016.01.044

    Article  PubMed  Google Scholar 

  10. Mayda-Domac F, Mısırlı H, Yılmaz M (2010) Prognostic role of mean platelet volume and platelet count in ischemic and hemorrhagic stroke. J Stroke Cerebrovasc Dis 19(1):66–72. https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.03.003

    Article  PubMed  Google Scholar 

  11. Riddle Matthew C et al (2018) American diabetes association: standards of medical care in diabetes. J Clin Appl Res Educ 41:13–27. https://doi.org/10.2337/dc18-SPPC01

    Article  Google Scholar 

  12. James PA et al (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 5(5):507–520. https://doi.org/10.1001/jama.2013.284427.311

    Article  Google Scholar 

  13. Posfai E, Marton I, Szoke A, Borbényi Z, Vecsei L, Csomor A et al (2014) Stroke in essential thrombocythemia. J Neurol Sci 336(1–2):260–262. https://doi.org/10.1016/j.jns.2013.10.016

    Article  PubMed  Google Scholar 

  14. Park HK, Lee SH (2014) Ischemic stroke associated with immune thrombocytopenia: lesion patterns and characteristics. Neurol Sci 35(11):1801–1806. https://doi.org/10.1007/s10072-014-1843-0

    Article  PubMed  Google Scholar 

  15. Sico JJ, Phipps MS, Concato J, Wells CK, Lo AC, Nadeau SE et al (2013) Thrombocytopenia and in-hospital mortality risk among ischemic stroke patients. J Stroke Cerebrovasc Dis 22(7):e99–e102. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.08.005

    Article  PubMed  Google Scholar 

  16. Schiffer CA, Bohlke K, Delaney M et al (2018) Platelet transfusion for patients with cancer: American Society of Clinical Oncology clinical practice guidelines update. J Clin Oncol 36:283–299. https://doi.org/10.1200/JCO.2017.76.1734

    Article  PubMed  Google Scholar 

  17. Zhang YY, Chan DKY, Cordato D (2006) Stroke risk factor, pattern and outcome in patients with cancer. Acta Neurol Scand 114(6):378–383. https://doi.org/10.1111/j.1600-0404.2006.00709.x

    Article  PubMed  Google Scholar 

  18. Cestari DM, Weine DM, Panageas KS (2004) Stroke in patients with cancer: incidence and etiology. Neurology 62(11):2025–2030. https://doi.org/10.1212/01.WNL.0000129912.56486.2B

    Article  CAS  PubMed  Google Scholar 

  19. Zhang YY, Cordato D, Shen Q et al (2007) Risk factor, pattern, etiology and outcome in ischemic stroke patients with cancer: a nested case-control study. Cerebrovasc Disease 23:181–187. https://doi.org/10.1159/000097639

    Article  CAS  Google Scholar 

  20. Nguyen T, DeAngelis LM (2006) Stroke in cancer patients. Curr Neurol Neurosci Rep 6(3):187–192. https://doi.org/10.1007/s11910-006-0004-0

    Article  PubMed  Google Scholar 

  21. Bang OY, Seok JM, Kim SG et al (2011) Ischemic stroke and cancer: stroke severely impacts cancer patients, while cancer increases the number of strokes. J Clin Neurol 7(2):53–59. https://doi.org/10.3988/jcn.2011.7.2.53

    Article  PubMed  PubMed Central  Google Scholar 

  22. Navi BB, Iadecola C (2018) Ischemic stroke in cancer patients: A review of an underappreciated pathology. Ann Neurol. https://doi.org/10.1002/ana.25227 (in press)

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kneihsl M, Enzinger C, Wünsch G et al (2016) Poor short-term outcome in patients with ischaemic stroke and active cancer. J Neurol 263(1):150–156. https://doi.org/10.1007/s00415-015-7954-6

    Article  CAS  PubMed  Google Scholar 

  24. Rodrigues M, Costa R, Brito S, Pissarra A, Lourenço A, Grenho F, Campos L (2016) Ischemic stroke and cancer correlation: a stroke unit experience. Ann Oncol 28(5):40

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neuro-oncology Unit, Instituto Nacional de Cancerología, Av. San Fernando 22. Col. Sección XVI. Tlalpan, ZC 14080, Mexico City, Mexico

    Bernardo Cacho-Díaz, Héctor Spínola-Maroño & Laura G. Mendoza-Olivas

  2. Research Unit, Instituto Nacional de Cancerología, Mexico City, Mexico

    Myrna Candelaria

Authors
  1. Bernardo Cacho-Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Héctor Spínola-Maroño
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura G. Mendoza-Olivas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Myrna Candelaria
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernardo Cacho-Díaz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research and ethics committees.

Informed consent

Informed consent was not considered necessary by the institutional research and ethics committees for this was a retrospective observational study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cacho-Díaz, B., Spínola-Maroño, H., Mendoza-Olivas, L.G. et al. Platelet count is associated with outcome in cancer patients with stroke. J Neurooncol 140, 569–574 (2018). https://doi.org/10.1007/s11060-018-2982-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-018-2982-6

Keywords

Search

Navigation