Abstract TP057: Antithrombotic Use Patterns for Secondary Stroke Prevention in Ischemic Stroke Patients with Active Malignancy: The STOP-SPAM Study

Background/Objective: Active malignancy increases the risk of ischemic stroke through multiple mechanisms, including cancer-associated hypercoagulability which has led to debate regarding secondary stroke prevention strategies. We aimed to further understand and model antithrombotic decision making and recurrent stroke within this population. Design: Single-center, retrospective cohort study from a single tertiary academic cancer center, of patients with active malignancy and ischemic stroke from 2015-2021. Patients with primary hemorrhage, clear indication for antiplatelet or anticoagulant, carotid intervention, or death within 30 days were excluded. Regression identified independent predictors of antithrombotic selection. Results: 1909 patients were reviewed with 306 patients included who met inclusion criteria. A total of 237 patients were prescribed antiplatelet agents and 69 were prescribed anticoagulant after stroke. The anticoagulant cohort had a higher frequency of Black race (47.8% vs. 32.9%), lung cancer (37.7% vs. 21.5%), pancreatic cancer (18.8% vs. 5.1%), and metastatic disease (88.4% vs. 49.4%). Regression analysis found metastatic disease (OR 8.39, 95% CI 3.86-18.25, p