Therefore, no recommendations can be made for the use of triptans and calcitonin gene related peptide receptors in patients with migraine and prior ischemic stroke. Future studies will be required to better understand the safety of triptans and calcito- nin gene related peptide receptor antagonists in this population. Recommendation for Malignancy Referenced studies that support the recommendation are summarized in online Data Supplement 48. COR LOE Recommendation In patients with ischemic stroke or TIA in the setting of AF and cancer, it is reasonable to consider anticoagulation with DOACs in preference to warfarin for stroke preven- Synopsis Patients with cancer are a population at high risk for The association between cancer and stroke is not surprising given the prevalence of these conditions and the commonly shared risk factors.652 Unfortunately, secondary stroke prevention in the setting of cancer is complicated by the paucity of data in the context of multiple pathogenic mechanisms.652 Potential mecha- nisms include procoagulant conditions, direct invasion or compression of blood vessels, radiation arteriopathies, infections (eg, aspergillosis), and secondary effects of chemotherapy (eg, thrombotic microangiopathy or car- The procoagulant mechanisms have been a main focus of the stroke prevention efforts in these patients, and antiplatelets or anticoagulants are often prescribed. However, there is uncertainty about how to best treat a potential acquired hypercoagulable state,653 including the best choice for antithrombotic agent. Low- molecular-weight heparin agents are commonly used empirically when a hypercoagulable state is suspected, but the benefit is unclear,654 particularly in this patient population with a high tendency for hemorrhage.651 A specific situation in these patients that has been more adequately studied is the best anticoagulation regimen for the prevention of cardioembolism from AF,651 which is extrapolated from subgroup analysis of the large ran- domized clinical trials of anticoagulation. 