
Chemotherapy can cause blood clots, which can lead to a stroke. Blood clots are a jelly-like mass of thickened blood, which can block an artery or vein and stop the blood flow, termed thrombus. A thrombus in a brain artery can cause a stroke.
Several factors, including chemotherapy, can increase the risk of blood clots. However, blood clots can also be caused by biological factors not related to cancer or chemotherapy treatments.
Characteristics | Values |
---|---|
--- | --- |
Cancer-associated stroke | Cancer may mediate stroke pathophysiology either directly or via coagulation disorders that establish a state of hypercoagulation, as well as via infections. |
Cancer treatment options, such as chemotherapy, radiotherapy, and surgery have all been shown to aggravate the risk of stroke as well. | |
The clinical manifestation varies greatly depending upon the underlying cause; however, in general, cancer-associated strokes tend to appear as multifocal in neuroimaging. | |
Several serum markers have been identified, such as high D-Dimer levels and fibrin degradation products. | |
Managing cancer patients with stroke is a delicate matter. | |
The cancer should not be considered a contraindication in applying thrombolysis and recombinant tissue plasminogen activator (rTPA) administration, since the risk of hemorrhage in cancer patients has not been reported to be higher than that in the general population. | |
Anticoagulation, on the contrary, should be carefully examined. Clinicians should weigh the benefits and risks of anticoagulation treatment for each patient individually; the new oral anticoagulants appear promising; however, low-molecular-weight heparin remains the first choice. | |
On the whole, stroke is a serious and not a rare complication of malignancy. | |
Clinicians should be adequately trained to handle these patients efficiently. |
What You'll Learn
- Chemotherapy can cause blood clots, which can lead to a stroke
- Chemotherapy can cause hypercoagulability, which can lead to a stroke
- Chemotherapy can cause non-bacterial thrombotic endocarditis, which can lead to a stroke
- Chemotherapy can cause direct tumour compression of blood vessels, which can lead to a stroke
- Chemotherapy can cause post-radiation vasculopathy, which can lead to a stroke
Chemotherapy can cause blood clots, which can lead to a stroke
Chemotherapy can increase the risk of blood clots, which can lead to a stroke. Blood clots are a jelly-like mass of thickened blood. Blood clots can block an artery or vein, stopping the blood flow, which is known as a thrombus. A thrombus in a brain artery can cause a stroke. A thrombus in the leg or pelvic vein is known as deep vein thrombosis (DVT).
Several factors, including chemotherapy, can increase the risk of blood clots. Cancer patients are at higher risk of developing blood clots in their veins, particularly in the legs and lungs. Oncologists already consider the risk of venous thromboembolism when treating patients.
Cancer and stroke may occur independently, or cancer may directly or indirectly lead to a stroke via hypercoagulability, non-bacterial thrombotic endocarditis (NBTE), direct tumour compression of blood vessels, or treatment-related effects.
The most frequent causes of stroke in cancer patients are traditional cerebrovascular risk factors such as hypertension, hyperlipidemia, diabetes, atrial fibrillation and tobacco use. However, the classification of "cryptogenic" stroke, meaning that no cause was identified despite detailed investigation, is more common in stroke patients with cancer.
Several mechanisms, supported by multiple lines of evidence, may link stroke with cancer. Cancer patients with cryptogenic stroke were found to have elevated D-Dimer levels compared to stroke patients without malignancy.
Perhaps the most important and underreported mechanism by which cancer can cause stroke is via abnormal coagulation cascades. The eponymous Trousseau’s syndrome, first described in 1865, referred to migratory thrombophlebitis in a patient with a visceral carcinoma, but has since been expanded to describe any hypercoagulable state associated with cancer. Coagulation disorders, such as disseminated intravascular coagulation (DIC), are more likely to be seen in stroke patients with cancer than without.
Although many malignancies have been associated with hypercoagulability, adenocarcinoma is frequently linked with clotting disorders as well as malignancy-associated stroke and, therefore, bears special consideration. In Japan, the incidence of colorectal cancer has been reported to be 16 per 10,000 person-years for the general population; however, the incidence was found to be nearly 500 times in patients presenting initially with stroke. Mechanistically, adenocarcinomas are thought to potentiate thrombi via production of mucin, a high molecular weight “sticky” molecule that is glycosylated and secreted normally by endothelial cells.
Preventing Heat Stroke: Quick Action, Quick Cool-Down
You may want to see also
Chemotherapy can cause hypercoagulability, which can lead to a stroke
Chemotherapy can cause hypercoagulability, which is a condition where the blood becomes 'sticky' and more prone to clotting. This can lead to a stroke, as a blood clot can block an artery or vein and stop the blood flow, which is known as a thrombus. A thrombus in a brain artery can cause a stroke to occur.
Several factors can contribute to the creation of blood clots, including some types of chemotherapy. Cancer patients often undergo invasive procedures that can dislodge a clot, and tumours and cancer therapies can affect processes that influence the formation of clots, like coagulation and platelet function.
The risk of arterial thrombotic events like strokes and heart attacks has been underappreciated, and oncologists already consider the risk of venous thromboembolism when treating patients.
The most frequent causes of stroke in cancer patients are traditional cerebrovascular risk factors such as hypertension, hyperlipidemia, diabetes, atrial fibrillation and tobacco use. However, the classification of "cryptogenic" stroke, meaning that no cause was identified despite detailed investigation, is more common in stroke patients with cancer, suggesting an association between malignancy and unknown mechanisms leading to stroke.
In addition, patients with venous thromboembolism are more likely to be diagnosed with cancer in the ensuing years, suggesting that hypercoagulability may be an important first presentation in cancer.
Stroke Hallucinations: Understanding the Unexpected Side Effect
You may want to see also
Chemotherapy can cause non-bacterial thrombotic endocarditis, which can lead to a stroke
Non-bacterial thrombotic endocarditis (NBTE) is a rare condition characterised by the presence of vegetations on cardiac valves, which consist of fibrin and platelet aggregates and are devoid of inflammation or bacteria. NBTE is a potentially life-threatening source of thromboembolism to the brain, heart, spleen, kidney and other important organs. The pathogenesis of NBTE is not fully understood, but one hypothesis incriminates interleukins and tumour necrosis factor (TNF), released secondary to the interaction between monocytes or macrophages and malignant cells. This release of interleukins and TNF will cause endothelial damage and sloughing, which may lead to thrombogenesis on valvular surfaces as well as other sites in the bloodstream. Platelets and clotting factors may also be activated by this interaction, which could further facilitate thrombosis.
NBTE is difficult to diagnose and relies on strong clinical suspicion. It is also difficult to manage, and each case should be individually assessed by identifying and treating the underlying pathology. Surgical intervention is not recommended unless the patient is in acute congestive failure.
NBTE is a rare complication of malignancy and other hypercoagulable states. It describes the deposition of small sterile smooth or verrucoid vegetations on the valve leaflets, causing a clinical picture similar to that of bacterial endocarditis. The true incidence of NBTE is not known, but it can occur in any type of cancer except brain tumours. Cancers of the lung, pancreas, and stomach, in addition to adenocarcinomas of unknown primary sites, are the most common malignancies associated with NBTE.
Cancer is a hypercoagulable state, and cancer-associated thrombophilia can have a diverse clinical presentation, most commonly venous thromboembolism and rarely non-bacterial thrombotic endocarditis. The diagnosis of NBTE is difficult and requires a high level of suspicion. The treatment of NBTE focuses on treating the underlying disease while managing the risk for systemic embolization.
MI and Stroke: What's the Link?
You may want to see also
Chemotherapy can cause direct tumour compression of blood vessels, which can lead to a stroke
Yes, chemotherapy can cause direct tumour compression of blood vessels, which can lead to a stroke.
Chemotherapy can cause a stroke by increasing the risk of hypercoagulability, which is an abnormality in the blood's ability to clot. This can lead to the formation of blood clots and emboli, which can cause a stroke.
In addition, chemotherapy can cause a stroke by increasing the risk of non-bacterial thrombotic endocarditis (NBTE), which is a condition where sterile vegetations develop on cardiac valves. This can lead to systemic and cerebral thrombosis, which can cause a stroke.
Chemotherapy can also cause a stroke by increasing the risk of direct tumour compression of blood vessels. This can occur when a tumour grows and compresses a blood vessel, or when tumour bed oedema (swelling) compresses a blood vessel.
Finally, chemotherapy can cause a stroke by increasing the risk of intracranial haemorrhage (bleeding in the brain). This can occur when chemotherapy affects the formation of blood vessels, causing them to rupture and bleed.
Apple Cider Vinegar: A Stroke Patient's Friend or Foe?
You may want to see also
Chemotherapy can cause post-radiation vasculopathy, which can lead to a stroke
Chemotherapy is a treatment option for cancer patients, and it can cause post-radiation vasculopathy, which can lead to a stroke. Chemotherapy can lead to stroke via endothelial toxicity and abnormalities in coagulation and hemostasis factors. It can also trigger the manifestation of a stroke by transferring susceptibility via immunosuppression and the increase in opportunistic infections. Chemotherapy can also lead to stroke via abnormal coagulation cascades. The eponymous Trousseau’s syndrome, first described in 1865, referred to migratory thrombophlebitis in a patient with a visceral carcinoma, but has since been expanded to describe any hypercoagulable state associated with cancer. Coagulation disorders, such as disseminated intravascular coagulation (DIC), are more likely to be seen in stroke patients with cancer than without. Cancer patients with cryptogenic stroke were found to have elevated D-Dimer levels compared to stroke patients without malignancy.
Post-radiation vasculopathy occurs in intra-cranial and extracranial vessels, with medium and large-sized vessels being most frequently affected. The subsequent stenosis or occlusion is typically more extensive within the radiation portal, than the atherosclerosis which develops in its absence as well. Radiation to the neck has been related to subsequent vascular wall thickening, atherosclerotic plaque formation and vascular damage. Studies have also confirmed that RT predisposes to the formation of inflammatory plaques, which are more likely to rupture and cause a stroke, or a heart attack. Patients that have received RT to the head and neck area have also been shown to have significant internal carotid artery/common carotid artery stenosis. Thus, several studies using different methods and patients with varied disease processes have reported an increased risk of CVEs following RT for head and neck cancers or lymphoma.
Tofu's Benefits for Stroke Patients: What You Need to Know
You may want to see also
Frequently asked questions
Chemotherapy can cause a stroke via endothelial toxicity and abnormalities in coagulation and hemostasis factors. Chemotherapy can also trigger the manifestation of a stroke by transferring susceptibility via immunosuppression and the increase in opportunistic infections.
Common symptoms of a stroke include sudden numbness or weakness of the face, arm or leg, especially on one side of the body, sudden confusion, trouble speaking or understanding, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, and sudden severe headache with no known cause.
Seek emergency help immediately and notify your health care provider.