Abstract Details

Title Prudent testing of factor V Leiden in Ischemic stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-013

Objective To analyze the cost-effectiveness and outcome of factor V Leiden (fVL) testing in elderly patients admitted with the diagnosis of ischemic stroke.

Background

fVL mutation is a known risk factor for venous thrombosis and less commonly arterial thrombosis. A hypercoagulable panel is commonly ordered in search of stroke etiology, specifically cryptogenic stroke. A positive fVL has the potential to change secondary stroke prevention strategy in select patients. However, pre-test probability declines with age.

Design/Methods This is a retrospective study of 346 consecutive cases admitted to a primary stroke center over a period of 5 years with the diagnosis of ischemic stroke and fVL testing. These cases were analyzed by age and outcome of fVL testing.

Results Total 346 patient’s charts were reviewed. 12 of the 346 (3.5%) were above age 80, 93 (26.9%) were between 60-79 and remaining 241 (69.7%) were between 40-59. All patients >80 years had a negative test, 6 out of 93 (6.5%) patients between age group of 60-79 and 10 out of 241 (4.1%) patients between 40-59 were positive for the fVL testing. All positives were of heterozygous type. Interestingly despite a negative result repeat testing was ordered in 1 patient >80, 6 patients in age group 60-79 and 6 patients in age group of 40-59. Estimated cost for fVL testing in 12 patients who were >80 years was 10,548$ and in 13 repeat testing patients was 11,427$ (listed fee for fVL testing at our facility is $879)

Conclusions Factor V Leiden mutation testing is frequently considered in the workup of ischemic stroke. Testing was negative in all patients over age 80, though rare positive results were found in patients between 40-79. By limiting duplicate testing and restricting fVL to patients under the age of 80, cost savings can be significant.

Authors/Disclosures
Shivakrishna Kovi, MD, MBBS (Unity point Health) PRESENTER	Dr. Kovi has nothing to disclose.
Anthony Noto, MD (Geisinger Medical Center)	Dr. Noto has nothing to disclose.

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