Tissue Factor Activity and Ischemia

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.

This study evaluates the association between plasma TF activity and outcome in patients with AC and AIS.

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.

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).

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.