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Activated Protein C Resistance Does Not Increase Risk for Recurrent Stroke or Death in Stroke Patients
Markus Alexander Thaler1, Regina Feurer2, Christoph Thaler2
1Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
Insights
Activated protein C (APC) resistance, a common inherited clotting disorder, does not increase stroke recurrence or death risk in patients with a first ischemic stroke or TIA. Routine APC resistance testing is not recommended for these patients.
Area of Science:
- Hematology
- Neurology
- Thrombosis Research
Background:
- Activated protein C (APC) resistance is the most prevalent inherited prothrombotic condition.
- Its association with ischemic stroke risk and outcomes remains a subject of debate.
Purpose of the Study:
- To evaluate the impact of APC resistance on stroke recurrence and patient survival.
- This single-center study followed ischemic stroke and TIA patients.
Main Methods:
- Retrospective analysis of 966 patients with ischemic stroke or TIA.
- Follow-up to ascertain recurrent ischemic stroke or death outcomes.
- Multivariate analyses were performed on 858 patients with an 8.48-year follow-up.
Main Results:
- APC resistance did not significantly affect the incidence of recurrent stroke or overall survival.
- Hazard ratios for recurrent stroke and death were not elevated in APC-resistant patients.
- Subgroup analyses (young patients, cryptogenic stroke, atrial fibrillation) showed no increased risk.
Conclusions:
- APC resistance is not a predictive risk factor for subsequent stroke or mortality after an initial ischemic event or TIA.
- Routine laboratory testing for APC resistance in stroke patients is not clinically justified.
Background:
Activated protein C (APC) resistance is the most common inherited prothrombotic disorder. The role of APC resistance in ischemic stroke is controversially discussed.
Objectives:
The aim of this single center follow up study was to investigate the effect of APC resistance on stroke recurrence and survival in stroke patients.
Patients/Methods:
We retrospectively identified 966 patients who had had an ischemic stroke or transitory ischemic attack (TIA) and in whom laboratory tests for APC resistance had been conducted. These patients were contacted to determine the primary outcomes of recurrent ischemic stroke or death.
Results:
A total of 858 patients with an average follow up time of 8.48 years were included. APC resistance did not influence cumulative incidence functions for stroke free and total survival. In multivariate analyses, crude and adjusted hazard ratios for recurrent stroke as well as for death where not significantly increased in patients with APC resistance. This also applies to the subgroups of young patients, patients with cryptogenic stroke and patients with atrial fibrillation.
Conclusion:
APC-resistance is not a risk factor for subsequent stroke or death in patients with a first ischemic stroke or TIA. Testing for APC-resistance in stroke patients therefore cannot be routinely recommended.
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