Objective:

To analyze outcomes of intravenous (IV) tissue plasminogen activator (tPA) in cancer patients. 

Background:

IV thrombolysis is standard of care for patients with acute ischemic stroke (AIS)

Design/Methods:

We retrospectively analyzed outcomes of cancer patients and suspected AIS treated with IV tPA at Memorial Sloan Kettering Cancer Center (MSK) from 6/11/18 – 9/30/25. Active malignancy was defined as diagnosis or treatment of any malignant cancer within the past 6 months or known recurrent or metastatic disease. Importantly, MSK is not a designated stroke center, although it has an established acute stroke team activation system and 24-7 in-house neurology services.

Results:

Sixteen patients received tPA for presumed stroke during the study period. Median age was 71 years (range, 48-82); 6 patients were women. Twelve patients had active malignancy. No brain metastases or active CNS tumors. Initial median NIH Stroke Scale was 9 (range, 1-19) and Karnofsky performance status (KPS) was 100 (range, 20-100). After tPA, 9 patients were transferred to a comprehensive stroke center for further management, 1 was transferred locally for continued inpatient care, 1 died during the hospitalization, 2 were discharged home, and 3 to a rehabilitation center. Median KPS upon discharge was 60 (range, 0-90). Clinically significant systemic hemorrhage was reported in 2 patients following tPA: 1 bled at the site of recent abdominal surgery; 1 developed hemorrhage at a contusion site. No patients developed intracranial hemorrhage. Five patients with active malignancy resumed cancer-directed therapy within 3 months after the stroke. Median overall survival after tPA was 50.48 months (0-80 months). 

Conclusions:

Our study suggests that treating carefully selected cancer patients and AIS with IV thrombolysis at a dedicated cancer center is feasible and safe. Further, a sizeable proportion of patients continued cancer-directed therapy and lived several years. These factors should be considered when weighing thrombolysis decisions in the oncological population.