*10.2. CVAs*

CVAs remain one of the major causes of mortality and disability globally. The progress of imaging techniques, reperfusion therapy, and improved medical treatment during the last decades has significantly increased the life expectancy of these patients [102]. Although the optimal antithrombotic treatment is important to minimize the incidence of ischemic CVAs, the optimal regimen remains under investigation.

A recent guideline by the European Stroke Organization (ESO) strongly advises the administration of DAPT (aspirin + clopidogrel) for 21 days in patients with a noncardioembolic minor ischemic stroke or high-risk transient ischemic attack (TIA) during the last 24 h. Moreover, the experts recommend that DAPT (aspirin + ticagrelor) for 30 days may be beneficial in patients with non-cardioembolic mild-to-moderate ischemic stroke or high-risk TIA in the last 24 h [103].

According to a recent meta-analysis of randomized trials, short-term (for up to 3 months) DAPT seems to reduce the risk of recurrent stroke at the expense of a higher risk of major bleeding, compared with aspirin, in patients with high-risk TIA or mild to moderate ischemic strokes [104].

Cancer patients are at higher risk of suffering from acute CVAs and fatal strokes. In particular, patients with prostate, breast, and colorectum malignancies are more prone to fatal strokes [105]. Recently, Bang and colleagues [106] proposed that cancer-related strokes could be an emerging subtype of ischemic stroke, with unique underlying pathophysiological mechanisms. However, the existing literature and current evidence cannot adequately support the precise and tailored antithrombotic management of these patients.

#### **11. Conclusions**

Since oncologic patients are at high risk for both ischemic and bleeding events due to the dysregulation of their hemostatic system by cancer, the appropriate duration and the optimal agents of antiplatelet therapy after undergoing PCI and/or suffering from an ACS remain a challenge. The use of new technologies, such as DESs and OCT, may lead to shortened DAPT duration in all-comer patients, including patients with cancer. The optimal duration of DAPT is considered to be 1–3 months, consisting of aspirin and clopidogrel, while TAT can only be administered for a short period of time (up to 1 week in the hospital), followed by an NOAC and a single oral antiplatelet agent (preferably clopidogrel). Other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVA, may require DAPT. Although further studies are needed in order to establish the optimal duration and agents of DAPT, it is indisputable that a personalized and multidisciplinary approach is necessary to increase the life expectancy and quality of life of patients with cancer and CVD, along with finding the balance between thrombotic and bleeding risk.

**Author Contributions:** Conceptualization, G.T. and A.V.; methodology, G.T.; writing—original draft preparation, G.T., A.V., A.A. (Anastasios Apostolos), E.B., N.V.-B., G.V., E.-E.K., I.T., M.H., A.A. (Adel Aminian) and P.D.; writing—review and editing, G.T., A.V., A.A. (Anastasios Apostolos), E.B., N.V.-B., I.T., M.H., A.A. (Adel Aminian) and P.D.; supervision, G.T. and P.D. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** Not applicable.

**Conflicts of Interest:** The authors declare no conflict of interest.

## **References**


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