Abstract
BACKGROUND: Tissue factor (TF), the cellular receptor for plasma factor (F)VII/FVIIa and a key initiator of the extrinsic coagulation pathway, plays a central role in cancer-associated thrombosis. However, its prognostic significance in patients with active cancer (AC) and acute ischemic stroke (AIS) remains unclear. OBJECTIVES: This study evaluates the association between plasma TF activity and outcome in patients with AC and AIS. METHODS: We analyzed data from the SCAN study, a prospective, multicenter, observational study conducted in Japan. Blood samples were obtained immediately after admission, prior to any stroke treatment. TF activity was measured using a chromogenic assay. Patients were dichotomized at the median TF activity. Kaplan-Meier survival and Cox proportional hazards models were used to assess 1-year mortality, and restricted cubic spline analysis was conducted to explore nonlinear associations between TF activity and mortality. RESULTS: Among 135 patients with AC and AIS in the SCAN study database, 84 had available TF activity data. The median TF activity was 32.0 pM (IQR, 21.1-61.6 pM). Compared with the low TF activity group, the high TF activity group had a higher prevalence of distant metastasis (69% vs 40%; P = .009) and elevated D-dimer levels (median, 10.9 vs 2.7 μg/mL; P < .001). Kaplan-Meier analysis revealed significantly higher mortality in the high TF activity group (log-rank test, P < .001). High TF activity remained independently associated with increased mortality after adjustment for confounders (hazard ratio, 3.03; 95% CI, 1.29-7.12; P = .011). CONCLUSION: Elevated TF activity was independently associated with 1-year mortality in patients with AC and AIS. TF activity represents a potential prognostic biomarker in this population.