Background: Ischemic stroke (IS) may be the first sign of an occult cancer, due to an underlying paraneoplastic prothrombotic state. Predictors of occult cancer in acute IS, however, remain unclear. We performed a single-center study to identify clinical features that may distinguish cancer-associated IS from IS without recent cancer. Methods: We reviewed consecutive admissions for acute IS at our institution between January and December 2020. Recent cancer was defined as any new diagnosis of cancer up to five years prior to IS. We compared clinical features with Fisher and chi-squared tests for categorical data, as well as t-tests and Mann-Whitney U tests for continuous data. Results: We included 169 patients in the non-cancer group and 19 in the recent cancer group (median time for cancer diagnosis: 10.5 months). The most frequent primary site was the digestive system (n=5; 33.3%). Patients with recent cancer had a significantly lower mean BMI (19.3 vs 26.4 kg/m2; p=0.013), lower mean hemoglobin (123 vs 134 g/L; p=0.015), and more frequent prior venous thrombosis (15.8% vs 1.2%; p=0.008) than cancer-free patients. Conclusions: Clinical features such as lower BMI, lower hemoglobin and prior venous thrombosis may help identify cancer-associated mechanisms, as well as guide cancer screening, in IS.