A Model for Predicting Persistent Elevation of Factor VIII among Patients with Acute Ischemic Stroke

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• 作者：Alyana A. Samai ; MPH^* ; ^&dagger ; ; Amelia K. Boehme ; PhD ; MSPH^&Dagger ; ; ^§ ; ; Amir Shaban ; MD^* ; Alexander J. George ; BS^* ; Lauren Dowell ; MS^* ; Dominique J. Monlezun ; BA^* ; Cindy Leissinger ; MD^‖ ; Laurie Schluter ; RN ; MSN ; FNP^* ; Ramy El Khoury ; MD^* ; Sheryl Martin-Schild ; MD ; PhD^* ; ^{smartin2@tulane.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Ischemic stroke ; blood coagulation ; biomarker ; thrombosis ; factor VIII
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：25
• 期：2
• 页码：428-435
• 全文大小：486 K

文摘

Elevated levels of coagulation factor VIII (FVIII) may persist independent of the acute-phase response; however, this relationship has not been investigated relative to acute ischemic stroke (AIS). We examined the frequency and predictors of persistently elevated FVIII in AIS patients.

Methods

AIS patients admitted between July 2008 and May 2014 with elevated baseline FVIII levels and repeat FVIII levels drawn for more than 7 days postdischarge were included. The patients were dichotomized by repeat FVIII level for univariate analysis at 150% and 200% activity thresholds. An adjusted model was developed to predict the likelihood of persistently elevated FVIII levels.

Results

Among 1616 AIS cases, 98 patients with elevated baseline FVIII had repeat FVIII levels. Persistent FVIII elevation was found in more than 75% of patients. At the 150% threshold, the prediction score ranged from 0 to 7 and included black race, female sex, prior stroke, hyperlipidemia, smoking, baseline FVIII > 200%, and baseline von Willebrand factor (vWF) level greater than 200%. At the 200% threshold, the prediction score ranged from 0-5 and included female sex, prior stroke, diabetes mellitus, baseline FVIII level greater 200%, and baseline vWF level greater than 200%. For each 1-point increase in score, the odds of persistent FVIII at both the 150% threshold (odds ratio [OR] = 10.4, 95% confidence interval [CI] 1.63-66.9, P = .0134) and 200% threshold (OR = 10.2, 95% CI 1.82-57.5, P = .0083) increased 10 times.

Conclusion

Because an elevated FVIII level confers increased stroke risk, our model for anticipating a persistently elevated FVIII level may identify patients at high risk for recurrent stroke. FVIII may be a target for secondary stroke prevention.