# Intravenous thrombolysis in patients with acute ischaemic stroke and active cancer (the ITACA-stroke study)

## TL;DR

This study finds that intravenous thrombolysis may improve outcomes for stroke patients with active cancer, though it increases the risk of bleeding.

## Contribution

The study evaluates the safety and efficacy of IVT in stroke patients with active cancer, a previously unclear area.

## Key findings

- IVT was associated with better functional outcomes and lower mortality in stroke patients with active cancer.
- IVT increased the risk of intracranial and other haemorrhagic events.
- Propensity score matching confirmed the association between IVT and improved outcomes.

## Abstract

Current data regarding the effect of intravenous thrombolysis (IVT) in patients with acute ischaemic stroke (AIS) with concomitant malignancy remain unclear. This study aimed to evaluate the efficacy and safety of IVT in patients with AIS and concomitant active cancer.

The ITACA-stroke study was a retrospective observational study based on prospective registries of a multicentre international collaboration. Patients with a diagnosis of active cancer and AIS, treated or not with IVT, were enrolled. Multivariable logistic regression analysis was performed to identify independent predictors for functional outcomes (mortality and good functional outcome) and haemorrhagic events at 90 days. A propensity score matching (PSM) analysis compared IVT and no-IVT patients.

A total of 521 patients were included, 225 were treated with IVT and 296 were not treated with IVT. IVT was directly correlated with good functional outcome (OR: 2.56, 95% CI 1.45–4.52, p = 0.001), intracranial haemorrhage (ICH) (OR: 4.85, 95% CI: 2.09–11.22, p < 0.001) any haemorrhagic event (OR: 4.13, 95% CI: 1.99–8.57, p < 0.001), and inversely correlated with mortality (OR: 0.41, 95% CI: 0.22–0.74, p = 0.003). In the PSM comparison, IVT was directly associated with good functional outcome (OR: 2.09, 95% CI: 1.16–3.77, p = 0.014) and inversely correlated with mortality (OR: 0.31, 95% CI: 0.15–0.64, p = 0.001), but was not directly associated with haemorrhagic outcomes.

Treatment with IVT could be beneficial in patients with AIS and active cancer in terms of functional outcome and mortality. An association between IVT and the risk of haemorrhagic events was less clearly defined in this sample.

The online version contains supplementary material available at 10.1007/s00415-025-13458-6.