Hypercoagulation testing in ischemic stroke

The utility of laboratory testing for hypercoagulability in the setting of stroke is uncertain.

To review the current literature and to make recommendations with regard to laboratory testing for various hypercoagulability risk factors for ischemic stroke.

Published articles studying the utility of various hypercoagulation tests in predicting initial and/or recurrent stroke or transient ischemic attack as well as cerebral vein thrombosis were collected and reviewed, with an emphasis on prospective studies.

Certain tests, such as C-reactive protein, homocysteine, antiphospholipid antibodies, and lipoprotein(a), may be useful in patients with a history of stroke or at high risk for stroke, as evidenced by prospective data. Factor V Leiden, prothrombin G20210A, protein C, protein S, and antithrombin are not recommended for routine testing but may be useful in certain populations, such as in pediatric patients or in patients with cerebral vein thrombosis.