Pilot Trial Of Enoxaparin Versus Aspirin In Cancer Patients With Stroke: The Teach Study

Introduction: Anticoagulants are often used in cancer patients with acute ischemic stroke (AIS) because of concerns for hypercoagulability. However, cancer patients are also prone to bleeding. No prospective study has compared different antithrombotic strategies in this population. We aimed to perform the first randomized trial comparing anticoagulation to antiplatelet therapy in cancer patients with AIS. Methods: We conducted a pilot multicenter randomized trial in adult patients with active systemic cancer and MRI-confirmed AIS. Patients were randomized to subcutaneous enoxaparin (1 mg/kg twice daily) or oral aspirin (81 mg daily) for 6 months. Antithrombotic therapy beyond 6 months was dictated by treating clinicians. Exclusion criteria included clear indications for anticoagulant (e.g., DVT) or antiplatelet (e.g., recent stents) therapy, high-risk conditions for bleeding, symptomatic carotid stenosis, and severe hematologic derangements. Patients were followed at clinical visits at 1, 3, and 6 months ...