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We conducted a retrospective chart review between January 1^st, 2013 and December 31^st, 2018 of patients with active cancer and stroke and on either a DOAC or LMWH. Exclusion criteria were hemorrhagic stroke, brain metastases, hospice care or death within 1 month of initiation of new anticoagulant, no active malignancy at the time of stroke, and no confirmed stroke. Data was analyzed using Fisher’s exact test.  

Out of 1342 patients admitted with a diagnosis of ischemic stroke, 44 patients met the study inclusion criteria. The mean age was 73.5 ± 11.1 years and 36.4% were women. 18 patients had a stroke while on anticoagulation. After excluding one patient with a stroke on warfarin and two patients with a stroke on a DOAC and a recurrent stroke on LMWH, 15 patients had a stroke while on DOAC or LMWH.  The odds of stroke were higher in those on a DOAC vs. LMWH in unadjusted models (OR 5.46 95% CI 1.23 -24.09, p = 0.025) and after adjusting for age and sex (OR 6.01 95% CI 1.30 – 27.82, p = 0.022).

In this study, patients with cancer on DOAC vs. LMWH were more likely to have ischemic strokes.  Our study is a small retrospective study and thus further investigation of this important topic is warranted given the lack of overall study data.