title: Von Willebrand factor drives the association between elevated factor VIII and poor outcomes in patients with ischemic stroke.
abstract: OBJECTIVE
  Despite clear roles of factor VIII (FVIII) and von Willebrand factor (vWF) in thrombosis, few studies have examined the relationship of these factors with acute ischemic stroke (AIS). We sought to determine whether concurrent elevation in FVIII and vWF was associated with adverse events and outcomes.
  
  
  METHODS
  From our prospective stroke registry, patients consecutively admitted with AIS between July 2008 and October 2013 were included if both FVIII and vWF were measured during admission. The primary outcome was the modified Rankin Scale score on discharge.
  
  
  RESULTS
  Among 1453 cases in our stroke registry, 148 patients with AIS met inclusion criteria; 62 patients (41.9%) had FVIII-/vWF-, 16 patients (10.8%) had FVIII+/vWF-, and 51 patients (34.5%) had FVIII+/vWF+. In the fully adjusted model, patients with FVIII+/vWF+ had increased odds of inpatient complications (odds ratio, 8.6; 95% confidence interval, 1.58-46.85; P=0.013) and neuroworsening (odds ratio, 3.2; 95% confidence interval, 1.18-8.73; P=0.022) than patients with FVIII-/vWF-. Adjusted for age, baseline stroke severity, and glucose, patients with FVIII+/vWF+ had increased odds of poor functional outcome (modified Rankin Scale>2; odds ratio, 2.87; 95% confidence interval, 1.16-7.06; P=0.021) than patients with FVIII-/vWF-.
  
  
  CONCLUSIONS
  Concurrent FVIII/vWF elevation predicts higher odds of inpatient complications, neuroworsening, and worse functional outcomes for patients with AIS compared with patients with normal levels. Our findings suggest that FVIII and vWF levels may serve as clinically useful stroke biomarkers by providing risk profiles for patients with AIS.
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai).
authors.forename: Alyana
authors.initials: A
authors.lastname: Samai
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai).
authors.forename: Dominique
authors.initials: D
authors.lastname: Monlezun
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai).
authors.forename: Amir
authors.initials: A
authors.lastname: Shaban
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai).
authors.forename: Alexander
authors.initials: A
authors.lastname: George
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai).
authors.forename: Lauren
authors.initials: L
authors.lastname: Dowell
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kruse-Jarres
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai).
authors.forename: Laurie
authors.initials: L
authors.lastname: Schluter
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai).
authors.forename: Ramy
authors.initials: R
authors.lastname: El Khoury
authors.affiliation: From the Stroke Program, Department of Neurology (A. Samai, D.M., A. Shaban, A.G., L.D., L.S., R.E.K., S.M.-S.) and Section of Hematology/Oncology, Department of Medicine (R.K.-J.) Tulane University School of Medicine, New Orleans, LA; and Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA (A. Samai). smartin2@tulane.edu.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005169:Factor VIII / Q000378:metabolism*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000097:blood*; D013927:Thrombosis / Q000097:blood; D016896:Treatment Outcome; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D014841:von Willebrand Factor; D005169:Factor VIII
keywords: blood coagulation factors; factor VIII; stroke; thrombosis; von Willebrand factor