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Letter
Intravenous thrombolysis for acute stroke in patients with cancer
  1. Ignacio Casado-Naranjo1,2,
  2. Maria Luisa Calle1,
  3. Alfonso Falcón1,
  4. Ana Serrano1,
  5. Juan Carlos Portilla1,
  6. José María Ramírez-Moreno3
  1. 1Stroke Unit, Neurology Section, Hospital San Pedro de Alcántara, Cáceres, Spain
  2. 2Department of Biomedical Sciences, University of Extremadura, Badajoz, Spain
  3. 3Section of Neurology, Hospital Universitario Infanta Cristina, Badajoz, Spain
  1. Correspondence to Dr Ignacio Casado Naranjo, Stroke Unit, Section of Neurology, Hospital San Pedro de Alcántara, Cáceres 10003, Spain; icasadon{at}gmail.com

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Introduction

Current clinical guidelines recommend intravenous tissue plasminogen activator (tPA) as a specific treatment of ischaemic stroke up to 4.5 h of evolution in selected patients, according to eligibility criteria established in clinical trials in order to minimise the risk of major bleeding complications.1 These limitations on the use of tPA, which differ in European and American licences, are being overcome in clinical practice, having communicated their use in situations such as pregnancy, menstruation, recent surgery, previous stroke and others.2 Patients with malignant diseases were excluded not only from large trials of tPA but also from observational studies designed to evaluate the safety of treatment in daily practice.3 However, patients with cancer have an elevated risk for stroke,4 which may worse prognosis of the disease and may be associated with increased morbidity and mortality, so that thrombolytic therapy might be particularly beneficial if it were safe. The aim of our report is to describe our experience with three patients with malignant disease who developed an ischaemic stroke and were treated with intravenous tPA.

Case reports

Case 1

A 75-year-old man with a history of non-small-cell lung cancer (Stage 1B) presented to the emergency deparment …

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