Globally, hematologic malignancies are rising, with 1.34 million incident cases in 2019. ^{Reference Zhang, Wu and Wang1} Patients with these cancers have an increased stroke risk compared to those without cancer (HR 1.60, 95% CI 1.30–1.97). ^{Reference Yong, Mai and Matetić2} However, data on acute reperfusion therapy use in this population remain limited. This nationwide US analysis spanning three years examined key questions: How often do patients with hematologic malignancies receive reperfusion therapies? What are their outcomes? What are readmission rates?

Using the Nationwide Readmissions Database, Garg et al. found that patients with hematologic malignancies were significantly less likely to receive intravenous thrombolysis than the general population, while mechanical thrombectomy rates were similar. ^{Reference Garg, Eswaradass and Chopra3} Leukemia patients had higher in-hospital mortality, especially those with acute leukemia, who also had increased odds of subarachnoid hemorrhage (SAH) and non-routine discharge. Among lymphomas, Hodgkin lymphoma carried double the mortality risk compared to other lymphoma types. Overall, clinical outcomes were comparable to non-cancer patients, except for higher SAH rates in acute leukemia. Readmission rates for ischemic stroke were similar between cancer and non-cancer groups.

This is the first large-scale analysis of hyperacute stroke therapy in hematologic cancers – a heterogeneous group including lymphomas, leukemias, myelomas, plasma cell neoplasms and myeloproliferative disorders. Subtype-specific differences, such as worse outcomes in acute leukemia and Hodgkin lymphoma, underscore this heterogeneity. For example, even within “acute leukemia,” prognosis varies (e.g., Acute Lymphoblastic Leukemia [ALL] vs. Acute Myeloid Leukemia [AML]). Limitations of this study include reliance on administrative data, which omits treatment status, coagulopathy and imaging details that may influence decisions and outcomes. Kaplan–Meier curves without accounting for competing mortality risk further constrain interpretation, given high rates of mortality in this population. Similarly, the lack of difference in readmission rates for stroke may reflect a type II error due to dataset limitations.

Ultimately, given the paucity of data surrounding this topic, the authors should be commended for taking on the challenge of studying this question in an underserved population, where a large gap in evidence remains. This work moves the field forward by highlighting disparities in outcomes between certain subtypes of hematologic cancers after receipt of hyperacute stroke treatments and highlights the need for future research to consider the incorporation of cancer subtype characteristics, laboratory measures, stroke workflow measures, imaging features and provider concerns for hemorrhagic complications. In every case, a multidisciplinary, shared decision-making process weighing individualized risks against potential benefits conferred should be taken.