Abstract Details

Title Hypercoagulable States in Young Adults with Ischemic Stroke in a Stroke Belt State

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-009

Objective Evaluate ischemic stroke etiology in young adults at an academic medical center in the Stroke Belt.

Background The Stroke Belt, an area of the United States including Oklahoma, has the highest age-adjusted stroke mortality rate and highest incidence of recurrent ischemic stroke in the nation. We theorize that the increased stroke rates are due to nontraditional causes of ischemic stroke in young adults, specifically an increased prevalence of hypercoagulable states.

Design/Methods We conducted a chart review of 280 inpatients with first-ever ischemic stroke from age 18 to 55 years at an Oklahoma academic medical center from 7/1/2011 to 4/30/2017. Using Chi-squared test, we compared the stroke etiologic diagnosis of the attending neurologist at discharge—when hypercoagulable profile results were rarely available—to the diagnosis of a vascular neurologist postdischarge who had access to all available etiologic test results. All neurologists used a modified Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification with 7 categories: large-artery atherosclerosis, cardioembolism, small-artery occlusion, hypercoagulable states, nonatherosclerotic vasculopathies, hypoperfusion, and stroke of undetermined etiology.

Results The inpatient neurologists identified the stroke etiology as hypercoagulable state in 76 patients (27.34%) and undetermined etiology in 89 (32.01%). With the benefit of final hypercoagulable profile results, the postdischarge vascular neurologist identified the stroke etiology as hypercoagulable state in 144 (51.80%, 95% CI 45.94-57.61%, p-value 6.22e-9) and undetermined etiology in 28 (10.07%, 95% CI 7.06-14.17%, p-value 4.304e-10). There was no significant change in the proportion of ischemic strokes classified under all other stroke etiologies.

Conclusions Hypercoagulable states are a common cause of ischemic stroke in young adults in the U.S. Stroke Belt. Failure to perform a hypercoagulable profile in these patients may result in lost opportunities to optimize secondary stroke prevention strategies and may account for the increased risk of stroke mortality and recurrence in the Stroke Belt.

Authors/Disclosures
Sarah R. Durica, MD PRESENTER	An immediate family member of Dr. Durica has received personal compensation in the range of $100,000-$499,999 for serving as a Employee with Federal Aviation Administration.
Joshua Santucci, MD (Cleveland Clinic)	Dr. Santucci has nothing to disclose.
Sama Astani, MD	Dr. Astani has nothing to disclose.
Chad J. Stuckey, MD (University of Oklahoma Health Science Center)	No disclosure on file
Claire E. Delpirou Nouh, MD (University of Oklahoma Health Science Center, Department of Neurology)	The institution of Dr. Delpirou Nouh has received research support from Oklahomas Nathan Shock Center. Dr. Delpirou Nouh has a non-compensated relationship as a Volunteer/Board member with Oklahoma Alzheimer Association that is relevant to AAN interests or activities.
Chao Xu	Chao Xu has nothing to disclose.
David L. Gordon, MD, FAHA, FANA, FAAN (University of Oklahoma HSC)	Dr. Gordon has nothing to disclose.

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