Abstract DP299: Oral antithrombotic therapy for patients with stroke and active cancer: A secondary analysis of BAT 2 study

Introduction: Patients with ischemic stroke (IS) or transient ischemic attack (TIA) who also have cancer are at risks for ischemic and bleeding events, and mortality. The optimal oral antithrombotic therapy for secondary stroke prevention in patients with cancer remains unclear. This study aimed to reveal the differences in recurrent IS, major bleeding (MB), and all-cause mortality in patients with IS/TIA who had with cancer. Methods: In this investigator-initiated, prospective, multicenter, observational study, patients with cerebrovascular or cardiovascular diseases, who were taking oral antiplatelet and/or anticoagulant agents, were enrolled from October 2016 to April 2019. For this secondary analysis, we collected data on patients with IS/TIA receiving oral antithrombotic therapy for secondary stroke prevention. Patients with uncured cancer was defined as active cancer (AC) and others as non-cancer groups. Results: Of the 4,727 patients (median age: 72 [IQR: 65–79] years; 1,561 [33.0%] women) with IS/TIA, 91 (1.9%) had AC. Of all patients, 3,354 were treated with antiplatelet agent [65, 1.9% with cancer], 1,134 patients to anticoagulant agent [17, 1.5%], and 239 patients to combination therapy [9, 3.8%]. The 1-year rates of recurrent IS (3.4% vs. 2.5%, HR 1.20, 95%CI 0.45-3.24) and MB (0% vs. 1.1%, HR 1.32, 95%CI 0.33-5.39) were not significantly different between AC and non-cancer groups. However, the 1-year mortality rate was significantly higher in the AC than non-cancer group (7.7% vs. 2.1%, HR 5.61, 95%CI 3.41-9.24). In the AC group (median age: 78 [IQR: 70–83] years; 26 [28.6%] women; 65 patients to antiplatelet; 17 anticoagulant; 9 combination], the 1-year rates of recurrent IS (3.2%, 5.9%, 0%), MB (3.2%, 5.9%, 0%) and mortality (4.6%, 17.6%, 11.1%) were not significantly different between antiplatelet, anticoagulant, and combination therapy, respectively. The multivariable Cox regression analysis revealed that female (aHR 0.13, 95%CI 0.02-0.76), dyslipidemia (aHR 0.19, 95%CI 0.04-0.83), CRP (aHR 1.45, 95%CI 1.16-1.80) and D-dimer (aHR 1.17, 95%CI 1.05-1.31) were independent predictor of mortality. Conclusion: Patients with IS/TIA and AC had a higher risk of mortality than those without cancer. The type of oral antithrombotic agent was not associated with recurrent IS, MB or mortality.