Antithrombotic therapy for secondary stroke prevention in patients with cancer: a systematic review and network meta-analysis.

IF 2.4 3区医学 Q3 PHARMACOLOGY & PHARMACY

European Journal of Clinical Pharmacology Pub Date : 2025-05-07 DOI:10.1007/s00228-025-03847-1

Leonardo Zumerkorn Pipek, Rafaela Farias Vidigal Nascimento, Sabrina Isabel Coronel, Mark Baker, Fernando Mayor Basto, Guilherme Diogo Silva

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引用次数: 0

Abstract

Background: The risk of stroke among patients with cancer is two times that of the general population due to a combination of cancer-, chemotherapy-, radiotherapy-, and surgery-related factors. There is a paucity of data regarding the optimal antithrombotic therapy for secondary stroke prevention in these patients.

Objectives: Our goal was to review the stroke recurrence in patients treated with different antithrombotic therapies (antiplatelets, warfarin, heparin, and direct oral anticoagulants). Our secondary objective was to review the bleeding risk across different antithrombotic therapies.

Methods: A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles that adequately assessed secondary prevention of stroke in patients with cancer were selected from the PubMed, Embase, and Scopus databases from inception until March 2, 2025. We performed a network meta-analysis for stroke recurrence, major bleeding, and mortality. The treatments were ranked by P-SCORE. Subgroup analyses were conducted based on median D-dimer levels, multiple territories of stroke, and exclusion of studies with high risk of bias.

Results: We included 11 studies (four RCTs, six retrospective studies, and one case series) with a total of 1319 patients. In the primary analysis, antiplatelets were the highest-ranked treatment for reducing stroke recurrence (RR 0.44 [0.20; 0.96]), followed by LMWH (RR 0.50 [0.26; 0.96]), both significantly superior to no treatment. However, LMWH consistently ranked higher than antiplatelets in all subgroup analyses. There was no difference regarding major bleeding or mortality.

Conclusion: Antiplatelets can be considered an option for secondary prevention of stroke in patients with cancer, especially in patients with a higher bleeding risk. Future research with high-quality studies is needed to confirm our preliminary findings and should focus on identifying subgroups of patients with cancer who may benefit most from specific antithrombotic therapies.

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抗血栓治疗对癌症患者继发性卒中预防的作用：系统回顾和网络荟萃分析。

背景：由于癌症、化疗、放疗和手术相关因素的综合作用，癌症患者发生中风的风险是一般人群的两倍。关于这些患者继发性卒中预防的最佳抗血栓治疗的数据缺乏。目的：我们的目的是回顾接受不同抗血栓治疗（抗血小板、华法林、肝素和直接口服抗凝剂）的患者卒中复发情况。我们的次要目的是回顾不同抗血栓治疗的出血风险。方法：按照系统评价和荟萃分析指南的首选报告项目进行文献综述。从PubMed， Embase和Scopus数据库中选择了从开始到2025年3月2日充分评估癌症患者卒中二级预防的文章。我们对中风复发、大出血和死亡率进行了网络荟萃分析。采用P-SCORE对治疗进行排序。亚组分析基于中位d -二聚体水平、卒中的多个领域和排除高偏倚风险的研究。结果：我们纳入了11项研究（4项随机对照试验，6项回顾性研究和1例病例系列），共1319例患者。在初步分析中，抗血小板是降低卒中复发的最高级别治疗(RR 0.44 [0.20；0.96])，其次是低分子肝素(RR 0.50 [0.26；0.96])，均显著优于未治疗。然而，在所有亚组分析中，低分子肝素的排名始终高于抗血小板。在大出血和死亡率方面没有差异。结论：抗血小板可被认为是癌症患者中风二级预防的一种选择，特别是对于出血风险较高的患者。未来需要高质量的研究来证实我们的初步发现，并应侧重于确定可能从特定抗血栓治疗中获益最多的癌症患者亚组。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Pharmacology 医学-药学

CiteScore

5.40

自引率

3.40%

发文量

170

审稿时长

3-8 weeks

期刊介绍： The European Journal of Clinical Pharmacology publishes original papers on all aspects of clinical pharmacology and drug therapy in humans. Manuscripts are welcomed on the following topics: therapeutic trials, pharmacokinetics/pharmacodynamics, pharmacogenetics, drug metabolism, adverse drug reactions, drug interactions, all aspects of drug development, development relating to teaching in clinical pharmacology, pharmacoepidemiology, and matters relating to the rational prescribing and safe use of drugs. Methodological contributions relevant to these topics are also welcomed. Data from animal experiments are accepted only in the context of original data in man reported in the same paper. EJCP will only consider manuscripts describing the frequency of allelic variants in different populations if this information is linked to functional data or new interesting variants. Highly relevant differences in frequency with a major impact in drug therapy for the respective population may be submitted as a letter to the editor. Straightforward phase I pharmacokinetic or pharmacodynamic studies as parts of new drug development will only be considered for publication if the paper involves -a compound that is interesting and new in some basic or fundamental way, or -methods that are original in some basic sense, or -a highly unexpected outcome, or -conclusions that are scientifically novel in some basic or fundamental sense.