ISC 2026 | Anticoagulant usage and risk of thromboembolic events after ischemic stroke in adults with cancer
Pargol Balali, MD, University of Pennsylvania, Philadelphia, PA, shares insights from a retrospective cohort study exploring anticoagulant usage and risk of thromboembolic events after ischemic stroke in adults with cancer. Dr Balali emphasizes the need for further research to address the clinically important question of anticoagulant use in patients with cancer and stroke. This interview took place at the 2026 International Stroke Congress (ISC), held in New Orleans, LA.
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Transcript
We did a retrospective study using Optum’s insurance data on a national level in the U.S. in patients who had cancer and a stroke. So we found about 86,000 patients with a stroke and about 10% of them had cancer, active cancer at the time of their stroke. And although the risk of recurrent thromboembolic event at six months was very high in this patient, it was 38 per 100 patient-years, and over two-thirds of them were due to ischemic stroke, only 15% of them were prescribed anticoagulants, which is pretty low compared to the data of patients who had cancer and DVT...
We did a retrospective study using Optum’s insurance data on a national level in the U.S. in patients who had cancer and a stroke. So we found about 86,000 patients with a stroke and about 10% of them had cancer, active cancer at the time of their stroke. And although the risk of recurrent thromboembolic event at six months was very high in this patient, it was 38 per 100 patient-years, and over two-thirds of them were due to ischemic stroke, only 15% of them were prescribed anticoagulants, which is pretty low compared to the data of patients who had cancer and DVT. About half of these patients are prescribed anticoagulants, but it’s not the same for a stroke. Although the risk of major bleeding, which is what physicians are most scared of, is kind of comparable between the groups. In our cohort, it was 21 per 100 patient-years, and it was kind of similar to the DVT literature. And we also investigated the association between anticoagulant use and risk of recurrent thromboembolic events. And in our cohort, anticoagulant did not decrease the risk of recurrent thromboembolic events and did not increase the risk of bleeding as well. But our results, given the retrospective nature of this study, could be confounded by indication: patients who had more severe cancer, metastatic cancer, or more embolic type of stroke may be more likely to receive anticoagulants per their physician’s opinion. And we need randomized clinical trial data to be able to answer this clinically important question.
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