Prognostic significance of coagulation factor activity in acute stroke: a retrospective cohort study

The coagulation system plays a critical role in the pathophysiology of stroke, extending beyond thrombosis to involve inflammatory immunity and microcirculatory regulation.

This study aimed to evaluate the association between the activities of coagulation factors VII, IX, XI, and XII and 90-day outcomes in ischemic and hemorrhagic strokes.

In this retrospective cohort study of 195 stroke patients recruited from May 2019 to March 2023, coagulation factors were measured within 24 h of admission. Multivariable logistic regression analysis was employed to assess their independent associations with post-stroke outcomes.

Out of 195 screened patients, 171 were included in the final analysis. Compared with patients with ischemic stroke (IS), those with hemorrhagic stroke (HS) were younger and presented with higher stroke severity, more severe consciousness disturbance, and higher INR levels (all p < 0.05). In the IS group, unfavorable 90-day prognosis was associated with higher levels of FXI and FXII activity (p < 0.05), but these associations disappeared after adjustment. In the HS group, unfavorable prognosis was associated with lower FVII and FIX activity, as well as higher FXI and FXII activity (p < 0.05). Multivariable logistic regression analysis revealed that in HS patients, after adjusting for potential confounders, FVII (OR = 0.464, 95% CI: 0.250-0.863, p = 0.015) and FIX activity (OR = 0.498, 95% CI: 0.249-0.998, p = 0.049) remained independently negatively associated with an unfavorable prognosis, while FXII activity (OR = 2.725, 95% CI: 1.098-6.762, p = 0.031) was independently positively associated with an unfavorable prognosis. Additionally, FXI activity in HS patients was weakly correlated with GCS and NIHSS scores.

Early coagulation factor activity showed subtype-specific associations with 90-day functional outcome, particularly in hemorrhagic stroke.