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Diagnostic testing for coagulopathies in patients with ischemic stroke
1Department of Medicine (Neurology), Duke Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University, and Durham VA Medical Center, Durham, NC 27710, USA.
Stroke
|January 11, 2000
Summary
Coagulation tests rarely identify clotting disorders in ischemic stroke patients, especially older adults. Ordering these tests strategically for younger patients with specific risk factors may improve diagnostic yield and reduce costs.
Area of Science:
- Neurology
- Hematology
- Medical Diagnostics
Background:
- Hypercoagulable states are an uncommon cause of ischemic stroke.
- The clinical utility of specialized coagulation testing in stroke management remains unclear.
Purpose of the Study:
- To quantitatively assess the diagnostic yield of coagulation tests for identifying coagulopathies in ischemic stroke patients.
- To determine the effectiveness of current diagnostic strategies.
Main Methods:
- Systematic review of controlled studies (1966-1999) identifying coagulopathies in ischemic stroke patients.
- Quantitative analysis using pretest and posttest probabilities and likelihood ratios.
- Stratification of data for patients aged 50 years or younger.
Main Results:
- Low cumulative prevalence rates for most tested coagulopathies (e.g., lupus anticoagulant: 3%, anticardiolipin antibodies: 17%, Factor V Leiden: 7%).
- Higher prevalence observed in patients aged 50 years or younger.
- Diagnostic yield for anticardiolipin antibodies, lupus anticoagulant, and Factor V Leiden increased with higher pretest probability and test specificity.
Conclusions:
- The overall pretest probability of coagulation defects in ischemic stroke patients is low.
- Targeting testing towards patients with specific clinical or historical risk factors can enhance diagnostic yield.
- Rational test ordering based on diagnostic yield data may lead to cost savings.