Abstract Details

Title Concurrent Elevation in Factor VIII and Antiphospholipid Antibodies Is Associated with Worse Outcome in Ischemic Stroke Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P06 - (-)

Poster/Presentation
Number 249

Objective

Background BACKGROUND: Elevations in FVIII or APLAs are independently associated with thrombosis. No prior studies have investigated concurrent elevations in these prothrombotic factors, which may be synergistic for risk, in patients with AIS.

Design/Methods DESIGN/METHODS: A retrospective review of prospectively identified consecutive patients with AIS was performed. Patients were included if 1) FVIII level was measured and 2) APLAs were tested. Elevated FVIII was defined as >150%. APLAs included beta2glycoprotein-, anticardiolipin-, and antiphosphotidylserine-antibodies and the Dilute Russell Viper Venom Time (DRVVT). Patients were divided into 4 groups: +FVIII/+APLA, +FVIII/-APLA, -FVIII/+APLA, and -FVIII/-ALPA. The groups were compared using Chi-square for categorical and Wilcoxon Rank sum for continuous variables.

Results RESULTS: Of the 133 patients who met criteria, 68% had elevated FVIII and 53% had elevation of 1 or more APLAs (the most common being DRVVT). There were no significant differences in age, race, sex, or baseline NIHSS between the four groups. Patients with +FVIII/+APLA had the highest median CRP (1.75 vs. 0.70 vs 0.35 vs 0.40, p<0.01) and ESR (21.5 vs 19.0 vs 14 vs 10, p=0.01) levels. +FVIII/+APLA patients had the highest frequency of neuroworsening (52.2% vs 39.1% vs 4.4% vs 4.8%, p=0.04), higher median discharge NIHSS (3 vs 2 vs 0 vs 1, p<0.01) and discharge mRS (3 vs 2 vs 1 vs 1, p=0.01), and longer median length of stay (7.0 vs 6.0 vs 3.0 vs 2.5, p<0.01).

Conclusions CONCLUSIONS: Subjects with concurrent elevations in FVIII and APLAs had worse outcomes despite similar baseline stroke severity compared to patients with one or less abnormal test. Further studies involving clotting factors are necessary to confirm this negative and synergistic relationship.

Authors/Disclosures
Laurie A. Schluter, RN, MSN, FNP (NP Health Solutions) PRESENTER	No disclosure on file
Amelia K. Boehme, PhD (Columbia University)	Dr. Boehme has nothing to disclose.
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.
Tiffany Chang, MD	Dr. Chang has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for National Football League.
Adrianne M. Parkey, MD	No disclosure on file
Aashit K. Shah, MD, FAAN (Carilion Clinic)	Dr. Shah has stock in Abbot, Abbivie, Gilead, Johnson and Johnson, Pfizer. The institution of Dr. Shah has received research support from Xenon Pharma.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sheryl Martin-Schild, MD, PhD, FAAN (Dr. Brain, Inc.)	No disclosure on file

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