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

Alyana A. Samai; Amelia K. Boehme; Amir Shaban; Alexander J. George; Lauren Dowell; Dominique J. Monlezun; Cindy Leissinger; Laurie Schluter; Ramy El Khoury; Sheryl Martin-Schild

doi:10.1016/j.jstrokecerebrovasdis.2015.10.015

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

Journal article

Peer reviewed

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

Alyana A. Samai, Amelia K. Boehme, Amir Shaban, Alexander J. George, Lauren Dowell, Dominique J. Monlezun, Cindy Leissinger, Laurie Schluter, Ramy El Khoury and Sheryl Martin-Schild

Journal of stroke and cerebrovascular diseases, Vol.25(2), pp.428-435

02/2016

DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.015

PMCID: PMC5022778

PMID: 26777556

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Abstract

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. 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. 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. 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.

biomarker

blood coagulation

factor VIII

Ischemic stroke

thrombosis

Details

Title: Subtitle: A Model for Predicting Persistent Elevation of Factor VIII among Patients with Acute Ischemic Stroke
Creators: Alyana A. Samai - Tulane University
Amelia K. Boehme - University of Alabama at Birmingham
Amir Shaban - Tulane University
Alexander J. George - Tulane University
Lauren Dowell - Tulane University
Dominique J. Monlezun - Tulane University
Cindy Leissinger - Tulane University
Laurie Schluter - Tulane University
Ramy El Khoury - Tulane University
Sheryl Martin-Schild - Tulane University
Resource Type: Journal article
Publication Details: Journal of stroke and cerebrovascular diseases, Vol.25(2), pp.428-435
DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.015
PMID: 26777556
PMCID: PMC5022778
NLM abbreviation: J Stroke Cerebrovasc Dis
ISSN: 1052-3057
eISSN: 1532-8511
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100000065, name: National Institute of Neurological Disorders and Stroke, award: T32 NS007153-31; DOI: 10.13039/100007875, name: Tulane University
Language: English
Date published: 02/2016
Academic Unit: Neurology
Record Identifier: 9984303017602771

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