Cancer-associated stroke: a comparative analysis of thrombus composition, resistance to lysis, and plasma biomarkers
Abstract
Background: Acute ischemic stroke (AIS) is a significant complication of cancer and may reveal occult malignancy. Whether cancer-related AIS (CAS) provides specific biological features remains unclear. Objectives: This case-control study aimed to characterize thrombi and plasmas from patients with CAS. Methods: Nine consecutive patients with CAS, including 3 nonbacterial thrombotic endocarditis (NBTE), and age-and sex-matched AIS controls with cardioembolism (CE, n = 16) or large artery atherosclerosis (LAA, n = 16) were included from the compoCLOT study. Thrombi retrieved after endovascular thrombectomy underwent ex vivo thrombolysis using recombinant tissue-type plasminogen activator and were analyzed for composition. Plasma biomarkers were also assessed. Results: CAS thrombi were resistant to tissue-type plasminogen activator lysis compared with LAA thrombi (median thrombus weight conservation, 92% vs 9%; P = .0002) and, to a lesser extent, compared with CE thrombi (92% vs 43%; P = .06). Thrombolysis resistance correlated negatively with red blood cell content (P < .0001) but positively with platelet factor-4 (P = .0014), von Willebrand factor (P = .0002) and DNA content (P < .0001). A subgroup of macroscopically white thrombi (n = 6), characterized by low red blood cell and high von Willebrand factor content, was identified in CAS, encompassing all 3 NBTE cases. Plasma D-dimer, fibrin monomers, extracellular vesicle-associated tissue factor and myeloperoxidase were significantly higher in patients with CAS than in the combined LAA and CE control groups (31,290 vs 1900 μg/L; 143 vs 9 μg/mL; 143 vs 9 fM; and 51 vs 25 ng/mL, respectively). Conclusions: CAS thrombi exhibit distinct properties, with white thrombi as a hallmark of undiagnosed NBTE. Furthermore, plasma biomarkers such as D-dimer, fibrin monomers, extracellular vesicle-associated tissue factor and myeloperoxidase could help in cancer screening in AIS of unknown etiology.
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BibTeX
@article{habay2026cancerassociated,
title = {{Cancer-associated stroke: a comparative analysis of thrombus composition, resistance to lysis, and plasma biomarkers}},
author = {Capucine Habay and Benoît Ho-Tin-Noé and Mialitiana Solo Nomenjanahary and Véronique Ollivier and Ilham Arab and Lina-Rose Kabbaj and Mikaël Mazighi and Nadine Ajzenberg and Jean-Philippe Desilles and Dorothée Faille},
journal = {Research and Practice in Thrombosis and Haemostasis},
year = {2026},
month = jun,
doi = {10.1016/j.rpth.2026.106787},
url = {https://hal.science/hal-05780469v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Cancer-associated stroke: a comparative analysis of thrombus composition, resistance to lysis, and plasma biomarkers
AU - Capucine Habay
AU - Benoît Ho-Tin-Noé
AU - Mialitiana Solo Nomenjanahary
AU - Véronique Ollivier
AU - Ilham Arab
AU - Lina-Rose Kabbaj
AU - Mikaël Mazighi
AU - Nadine Ajzenberg
AU - Jean-Philippe Desilles
AU - Dorothée Faille
PY - 2026
DA - 2026/06/11
JO - Research and Practice in Thrombosis and Haemostasis
DO - 10.1016/j.rpth.2026.106787
UR - https://hal.science/hal-05780469v1
AB - Background: Acute ischemic stroke (AIS) is a significant complication of cancer and may reveal occult malignancy. Whether cancer-related AIS (CAS) provides specific biological features remains unclear. Objectives: This case-control study aimed to characterize thrombi and plasmas from patients with CAS. Methods: Nine consecutive patients with CAS, including 3 nonbacterial thrombotic endocarditis (NBTE), and age-and sex-matched AIS controls with cardioembolism (CE, n = 16) or large artery atherosclerosis (LAA, n = 16) were included from the compoCLOT study. Thrombi retrieved after endovascular thrombectomy underwent ex vivo thrombolysis using recombinant tissue-type plasminogen activator and were analyzed for composition. Plasma biomarkers were also assessed. Results: CAS thrombi were resistant to tissue-type plasminogen activator lysis compared with LAA thrombi (median thrombus weight conservation, 92% vs 9%; P = .0002) and, to a lesser extent, compared with CE thrombi (92% vs 43%; P = .06). Thrombolysis resistance correlated negatively with red blood cell content (P < .0001) but positively with platelet factor-4 (P = .0014), von Willebrand factor (P = .0002) and DNA content (P < .0001). A subgroup of macroscopically white thrombi (n = 6), characterized by low red blood cell and high von Willebrand factor content, was identified in CAS, encompassing all 3 NBTE cases. Plasma D-dimer, fibrin monomers, extracellular vesicle-associated tissue factor and myeloperoxidase were significantly higher in patients with CAS than in the combined LAA and CE control groups (31,290 vs 1900 μg/L; 143 vs 9 μg/mL; 143 vs 9 fM; and 51 vs 25 ng/mL, respectively). Conclusions: CAS thrombi exhibit distinct properties, with white thrombi as a hallmark of undiagnosed NBTE. Furthermore, plasma biomarkers such as D-dimer, fibrin monomers, extracellular vesicle-associated tissue factor and myeloperoxidase could help in cancer screening in AIS of unknown etiology.
SN - 2475-0379
SN - 2475-0379
ER -