title: New Thrombotic Events in Ischemic Stroke Patients with Elevated Factor VIII.
abstract: Background. Heightened levels of Factor VIII (FVIII) have been associated with both arterial and venous thrombosis. While elevated FVIII is common during acute ischemic stroke (AIS), whether elevated FVIII confers an increased risk for recurrent thrombotic events (RTEs) following AIS has not been previously explored. Methods. Consecutive AIS patients who presented to our center between July 2008 and September 2013 and had FVIII measured during admission were identified from our stroke registry. Baseline characteristics and the occurrence of RTE (recurrent or progressive ischemic stroke, DVT/PE, and MI) were compared in patients with and without elevated FVIII levels. Results. Of the 298 patients included, 203 (68.1%) had elevated FVIII levels. Patients with elevated FVIII had higher rates of any in-hospital RTE (18.7% versus 8.4%, P = 0.0218). This association remained after adjustment for baseline stroke severity and etiology (OR 1.01, 95% CI 1.00-1.01, P = 0.0013). Rates of major disability were also higher in patients who experienced a RTE (17.8% versus 3.2%, P < 0.0001). Conclusion. A significantly higher frequency of in-hospital RTEs occurred in AIS patients with elevated FVIII. The occurrence of such events was associated with higher morbidity. Further study is indicated to evaluate whether FVIII is a candidate biomarker for increased risk of RTEs following AIS.
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Brittany M
authors.initials: BM
authors.lastname: Gouse
authors.affiliation: Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, 630 West 168 Street, New York, NY 10032, USA.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Dominique J
authors.initials: DJ
authors.lastname: Monlezun
authors.affiliation: Stroke Program, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2nd Floor, Ravdin Building, Philadelphia, PA 19104, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Siegler
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: George
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Brag
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA ; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), 1530 3rd Avenue South, Medical Towers, Birmingham, AL 35294, USA ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED), Medical Towers Building, 1717 11th Avenue South, Suite 516A, Birmingham, AL 35294, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Section on Statistical Genetics, Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA.
authors.forename: T Mark
authors.initials: TM
authors.lastname: Beasley
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Leissinger
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Ramy
authors.identifier: 0000-0003-0895-9091
authors.initials: R
authors.lastname: El Khoury
authors.affiliation: Stroke Program, Department of Neurology, Tulane University School of Medicine, 1440 Canal Street, TB-52, Suite 1000, New Orleans, LA 70112-2715, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild