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

Area of Science:

• Hematology
• Neurology
• Cardiovascular Medicine

Background:

• Elevated coagulation factor VIII (FVIII) levels can persist independently of acute-phase responses.
• The relationship between persistent FVIII and acute ischemic stroke (AIS) has not been extensively studied.

Purpose of the Study:

• To investigate the frequency of persistently elevated FVIII in AIS patients.
• To identify predictors of persistently elevated FVIII in AIS patients.

Main Methods:

• Analysis of AIS patients with elevated baseline FVIII and repeat FVIII levels drawn >7 days post-discharge.
• Dichotomization of patients by repeat FVIII levels at 150% and 200% activity thresholds.
• Development of an adjusted model to predict persistently elevated FVIII.

Main Results:

• Over 75% of AIS patients with elevated baseline FVIII showed persistent elevation.
• Predictors for persistent FVIII elevation included Black race, female sex, prior stroke, hyperlipidemia, smoking, and elevated baseline FVIII or von Willebrand factor (vWF).
• Each 1-point increase in the prediction score significantly increased the odds of persistent FVIII at both thresholds.

Conclusions:

• A predictive model for persistently elevated FVIII may identify AIS patients at high risk for recurrent stroke.
• Elevated FVIII levels are associated with increased stroke risk.
• Factor VIII may serve as a therapeutic target for secondary stroke prevention.