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Background and aim <p>Current data regarding the effect of intravenous thrombolysis (IVT) in patients with acute ischaemic stroke (AIS) with concomitant malignancy remain unclear. This study aimed to evaluate the efficacy and safety of IVT in patients with AIS and concomitant active cancer.</p> Methods <p>The ITACA-stroke study was a retrospective observational study based on prospective registries of a multicentre international collaboration. Patients with a diagnosis of active cancer and AIS, treated or not with IVT, were enrolled. Multivariable logistic regression analysis was performed to identify independent predictors for functional outcomes (mortality and good functional outcome) and haemorrhagic events at 90&#xa0;days. A propensity score matching (PSM) analysis compared IVT and no-IVT patients.</p> Results <p>A total of 521 patients were included, 225 were treated with IVT and 296 were not treated with IVT. IVT was directly correlated with good functional outcome (OR: 2.56, 95% CI 1.45–4.52, <i>p</i> = <i>0.001</i>), intracranial haemorrhage (ICH) (OR: 4.85, 95% CI: 2.09–11.22, <i>p</i> &lt; <i>0.</i>001) any haemorrhagic event (OR: 4.13, 95% CI: 1.99–8.57, <i>p</i> &lt; <i>0.001</i>), and inversely correlated with mortality (OR: 0.41, 95% CI: 0.22–0.74, <i>p</i> = <i>0.003</i>). In the PSM comparison, IVT was directly associated with good functional outcome (OR: 2.09, 95% CI: 1.16–3.77, <i>p</i> = <i>0.014</i>) and inversely correlated with mortality (OR: 0.31, 95% CI: 0.15–0.64, <i>p</i> = <i>0.001</i>), but was not directly associated with haemorrhagic outcomes.</p> Conclusions <p>Treatment with IVT could be beneficial in patients with AIS and active cancer in terms of functional outcome and mortality. An association between IVT and the risk of haemorrhagic events was less clearly defined in this sample.</p>

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Intravenous thrombolysis in patients with acute ischaemic stroke and active cancer (the ITACA-stroke study)

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  • 发表日期：

    2025年10月23日

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  • Virginia Cancelloni,
  • Giovanni Merlino,
  • Gianluca Costamagna,
  • Patrik Michel,
  • Marialuisa Zedde,
  • Ilaria Grisendi,
  • Rosario Pascarella,
  • Marina Padroni,
  • Gianvito Barbella,
  • Walter Ageno,
  • Elisa Ruggeri,
  • Simona Sacco,
  • Alessio Troisi,
  • Raffaele Ornello,
  • Marina Mannino,
  • Valeria Terruso,
  • Roberto Sperotto,
  • Arianna Cella,
  • Mariarosaria Valente,
  • Eugenia Rota,
  • Manuel Cappellari,
  • Francesco Valletta,
  • Mara Zenorini,
  • Matteo Foschi,
  • Antonio Genovese,
  • Tiziana Tassinari,
  • Valentina Saia,
  • Valeria Caso,
  • Cecilia Becattini,
  • Giorgio Maraziti,
  • Ilaria Leone de Magistris,
  • Michele Venti,
  • Andrea Alberti,
  • Alessandro Pezzini,
  • Michelangelo Mancuso,
  • Nicola Giannini,
  • Marco Baldini,
  • Elisa Grifoni,
  • Luca Masotti,
  • Michele Romoli,
  • Sebastiano Giacomozzi,
  • Georgios Tsivgoulis,
  • Lina Palaiodimou,
  • Aikaterini Theodorou,
  • Odysseas Kargiotis,
  • George Ntaios,
  • Orestis Tsiotsikas,
  • Efstathia Karagkiozi,
  • Anastasia Adamou,
  • Paraskevi Valarakou,
  • Nemanja Popovic,
  • Sanela Popovic,
  • Pietro Caliandro,
  • Aurelia Zauli,
  • Giuseppe Reale,
  • Marco Moci,
  • Laetitia Yperzeele,
  • Susanna Maria Zuurbier,
  • Alessandro Padovani,
  • Andrea Morotti,
  • Piergiorgio Lochner,
  • Maurizio Acampa,
  • Rossana Tassi,
  • Francesca Guideri,
  • Alberto Chiti,
  • Maurizio Paciaroni,
  • Maria Giulia Mosconi

摘要

Background and aim

Current data regarding the effect of intravenous thrombolysis (IVT) in patients with acute ischaemic stroke (AIS) with concomitant malignancy remain unclear. This study aimed to evaluate the efficacy and safety of IVT in patients with AIS and concomitant active cancer.

Methods

The ITACA-stroke study was a retrospective observational study based on prospective registries of a multicentre international collaboration. Patients with a diagnosis of active cancer and AIS, treated or not with IVT, were enrolled. Multivariable logistic regression analysis was performed to identify independent predictors for functional outcomes (mortality and good functional outcome) and haemorrhagic events at 90 days. A propensity score matching (PSM) analysis compared IVT and no-IVT patients.

Results

A total of 521 patients were included, 225 were treated with IVT and 296 were not treated with IVT. IVT was directly correlated with good functional outcome (OR: 2.56, 95% CI 1.45–4.52, p = 0.001), intracranial haemorrhage (ICH) (OR: 4.85, 95% CI: 2.09–11.22, p < 0.001) any haemorrhagic event (OR: 4.13, 95% CI: 1.99–8.57, p < 0.001), and inversely correlated with mortality (OR: 0.41, 95% CI: 0.22–0.74, p = 0.003). In the PSM comparison, IVT was directly associated with good functional outcome (OR: 2.09, 95% CI: 1.16–3.77, p = 0.014) and inversely correlated with mortality (OR: 0.31, 95% CI: 0.15–0.64, p = 0.001), but was not directly associated with haemorrhagic outcomes.

Conclusions

Treatment with IVT could be beneficial in patients with AIS and active cancer in terms of functional outcome and mortality. An association between IVT and the risk of haemorrhagic events was less clearly defined in this sample.