Abstract Details

Title Utility of the Hypercoagulable Panel in Decision Making for Cryptogenic Stroke and Patent Foramen Ovale

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-015

Objective To assess the utility of thrombophilia screening in determining candidacy for patent foramen ovale (PFO) closure for cryptogenic stroke patients <60 years old.

Background The predictive value of obtaining a hypercoagulable panel has been drawn into question, given its high cost and relatively low yield in altering clinical management. We report hypercoagulable panel findings and PFO closures in cryptogenic stroke patients < 60 with PFO to further assess the utility of thrombophilia screening in these patients.

Design/Methods This was a single-center retrospective chart review of 52 patients under the age of 60 with cryptogenic stroke found to have a PFO on transesophageal echocardiogram (TEE). Clinical and demographic data were collected, including normalcy of the hypercoagulable panel and PFO closure status. Association between an abnormal hypercoagulable panel and PFO closure was assessed using a two-tailed t-test at ? < 0.05.

Results A total of 45 patients underwent analysis. Hypercoagulable panel findings were abnormal in 25 patients (55.5%). These included abnormal levels of atherosclerotic markers which, given their transient nature, were deemed insignificant and were excluded from analysis (n=20). A remaining 5 patients had thrombophilic abnormalities. A total of 21 patients (46.7%) underwent PFO closure, 20 (95%) of whom had normal hypercoagulable panels. There was no significant difference in decision for PFO closure between patients with normal vs. abnormal panels (p=0.58). No evidence was found in documentation of PFO closure deferral due to abnormal hypercoagulable panel.

Conclusions In young patients with cryptogenic stroke due to PFO, hypercoagulable panel findings were largely normal. Abnormalities noted were transient and did not alter the decision for PFO closure. This suggests that obtaining a hypercoagulable panel in this population may be low-yield and is a possible target for cost reduction.

Authors/Disclosures
Riana Schleicher PRESENTER	Ms. Schleicher has nothing to disclose.
Jordan Houser, MD	Ms. Houser has nothing to disclose.
Bichun Ouyang	Bichum Ouyang has nothing to disclose.
Zain Ashary, MD (Rush University Medical Center)	An immediate family member of Dr. Ashary has received personal compensation for serving as an employee of AbbVie.
Rima Dafer, MD (Rush University Medical Center)	Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.

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