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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1813646
Review Article

Comparison of Antiplatelets and Anticoagulants for Secondary Stroke Prevention in Ischemic Stroke Patients with Cancer: A Meta-analysis

Autor*innen

  • Muhammad Shakir 

    1   Zeenat Qureshi Stroke Institute, and Department of Neurology, University of Missouri, Columbia, Missouri, United States

  • Moeez Ahmed

    1   Zeenat Qureshi Stroke Institute, and Department of Neurology, University of Missouri, Columbia, Missouri, United States

  • Hammad A. Irshad 

    2   Medical College, Aga Khan University, Karachi, Pakistan

  • Rafay Salman

    2   Medical College, Aga Khan University, Karachi, Pakistan

  • Eisha A. Ali 

    3   Medical College, University College of Medicine and Dentistry, Lahore, Pakistan

  • Daniel E. Ford

    4   Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland, United States

  • Daniel F. Hanley

    5   Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States

  • David R. Mehr

    6   Department of Geriatric Medicine, University of Missouri, Columbia, Missouri, United States

  • Chun S. Kwok

    7   Department of Cardiology, Mid Cheshire Hospitals NHS Trust, Crewe, United Kingdom

  • Wendy C. Ziai

    8   Department of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States

  • Adnan I. Qureshi

    1   Zeenat Qureshi Stroke Institute, and Department of Neurology, University of Missouri, Columbia, Missouri, United States
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Abstract

This study aims to assess the efficacy and safety of antiplatelets (oral and subcutaneous) and anticoagulants for secondary stroke prevention in ischemic stroke patients with cancer, where the optimal antithrombotic strategy remains unclear. A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, and Scopus (inception to June 2024). Studies were screened based on predefined criteria and assessed with the Newcastle-Ottawa Scale. A random-effects model (R 4.1.2) was used to calculate odds ratios (OR) with 95% confidence intervals (CI). A total of four studies were included in the final analysis. The cumulative sample size was 2,781 participants: 2,204 (79.2%) were treated with antiplatelets and 577 (20.7%) were treated with anti-coagulants. The mean age (± SD) of the patients was 69.56 (±9.88) years, and 65.7% were men. There was no difference in the risk of recurrent ischemic stroke between antiplatelets and anticoagulants (OR = 0.74, 95% CI: 0.31–1.77, 3 studies with 700 patients). There were no differences in the risk of gastrointestinal hemorrhage (OR = 1.74, 95% CI: 0.17–17.46, 2 studies with 2,101 patients) and any major hemorrhage (OR = 0.70, 95% CI: 0.24–2.05, 4 studies with 2781 patients). The odds of all-cause mortality were lower in patients treated with antiplatelets (OR = 0.73, 95% CI: 0.59–0.90, 4 studies involving 2,781 patients). Antiplatelets and anticoagulants showed no difference in recurrent stroke or major hemorrhagic events, but antiplatelets were associated with lower mortality. However, due to limited data, these findings may not fully answer the clinical question, highlighting the need for further high-quality studies.

Keywords

antiplatelet - anticoagulant - acute ischemic stroke - cancer - antithrombotic treatment

Authors' Contributions

M.S. contributed to the conceptualization, methodology, writing (review and editing), supervision, project administration, and formal analysis. M.A. was responsible for data curation. H.A.I. contributed to methodology and writing (review and editing). R.S. and E.A.A. were involved in data curation and writing (original draft). D.E.F., D.F.H., D.R.M., C.S.K., and W.Z. contributed to writing (review and editing). A.I.Q. was involved in conceptualization, supervision, and writing (review and editing).


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Publikationsverlauf

Artikel online veröffentlicht:
03. Dezember 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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