Intravenous thrombolysis for acute stroke in patients with cancer

Abstract

Current clinical guidelines recommend intravenous tissue plasminogen activator (tPA) as a specific treatment of ischaemic stroke up to 4.5 h of evolution in selected patients, according to eligibility criteria established in clinical trials in order to minimise the risk of major bleeding complications.1 These limitations on the use of tPA, which differ in European and American licences, are being overcome in clinical practice, having communicated their use in situations such as pregnancy, menstruation, recent surgery, previous stroke and others.2 Patients with malignant diseases were excluded not only from large trials of tPA but also from observational studies designed to evaluate the safety of treatment in daily practice.3 However, patients with cancer have an elevated risk for stroke,4 which may worse prognosis of the disease and may be associated with increased morbidity and mortality, so that thrombolytic therapy might be particularly beneficial if it were safe. The aim of our report is to describe our experience with three patients with malignant disease who developed an ischaemic stroke and were treated with intravenous tPA. ### Case 1 A 75-year-old man with a history of non-small-cell lung cancer (Stage 1B) presented to the emergency deparment …