Stroke secondary to cancer-associated coagulopathy: a systematic review
In brief
Cancer-related coagulopathy strokes kill up to half of patients within 30 days
A review of 82 studies found that strokes driven by cancer-associated coagulopathy occur mainly within six months of cancer diagnosis, often in advanced lung or pancreatic adenocarcinoma, and are marked by multiple infarcts across several brain territories. D-dimer levels predict recurrence and death, while treatment usually relies on low-molecular-weight heparin or DOACs, yet 30-day mortality remains 25-50%, underscoring the need for earlier detection and better antithrombotic strategies.
- Journal
- Journal of neurology (Q1)
- Published
- 20 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Carlota Jauregui Larrañaga, Emilio Gómez Arteta, Juan Marta Enguita, María Elena Erro Aguirre
- PMID
- 42763842
- DOI
- 10.1007/s00415-026-14119-y
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 27 September 2026): High-quality evidence in a top journal
- Picked for Hematology (top studies of the week, 27 September 2026): Stroke from cancer‑associated coagulopathy, not core haematology
- Picked for Histology (top studies of the week, 27 September 2026): High-quality evidence in a top journal
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 27 September 2026): High-quality evidence in a top journal
Abstract
BACKGROUND: Stroke is the second most common neurological complication in cancer patients after metastases. Cancer-associated coagulopathy (CAC) is an important mechanism of ischemic stroke in this population. We systematically reviewed the epidemiological, clinical, radiological, and pathophysiological features of CAC-related stroke, as well as associated biomarkers and treatment strategies. METHODS: A systematic search of PubMed/MEDLINE, Scopus, Cochrane Library, and Embase (2000-2025) was performed according to PRISMA 2020 guidelines. Search terms included "stroke", "cancer", "hypercoagulability", "coagulopathy", "disseminated intravascular coagulation", and "non-bacterial or marantic thrombotic endocarditis". Studies published in English or Spanish were included, whereas case reports and review articles were excluded. Data were synthesized qualitatively. RESULTS: Eighty-two studies met inclusion criteria. CAC-related stroke occurs predominantly within six months of cancer diagnosis and is strongly associated with advanced or metastatic disease and a high risk of early recurrence. Adenocarcinoma, particularly lung and pancreatic cancer, is the most frequently associated histological subtype. Proposed mechanisms include mucin-mediated platelet aggregation, tissue factor-driven coagulation, extracellular vesicles, and neutrophil extracellular trap formation, leading to thromboinflammation and platelet-rich thrombi. D-dimer is the biomarker most consistently associated with recurrence and mortality, while C-reactive protein, fibrinogen, CA-125, and transcranial Doppler microembolic signals show limited specificity. Characteristic imaging findings include multiple infarcts involving more than two vascular territories, particularly the 'three territories sign'. Low-molecular-weight heparin and direct oral anticoagulants are the most commonly used secondary prevention strategies. Thirty-day mortality rates range from 25 to 50%. CONCLUSIONS: CAC-related stroke is a distinct and underrecognized entity characterized by specific biological and radiological features and poor outcomes. Earlier recognition and optimized antithrombotic strategies may improve prognosis.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.