Prevalence and Predictors of Hypercoagulable Disorders in Patients With Concomitant Acute Limb Ischemia and Ischemic...

Background Acute limb ischemia (ALI) and ischemic stroke are serious arterial thrombotic presentations. When they occur in the same patient, particularly without an adequate conventional explanation, an underlying systemic thrombotic tendency may warrant investigation. However, evidence describing the frequency and clinical profile of hypercoagulable disorders in patients with concomitant ALI and ischemic stroke remains limited. Objective To determine the prevalence and spectrum of inherited and acquired hypercoagulable disorders among adults presenting with concomitant ALI and ischemic stroke and to identify clinical factors independently associated with a hypercoagulable state. Methods This prospective, hospital-based cross-sectional observational study was conducted in the Department of Neurology of a tertiary care teaching hospital in Bangladesh from January 2022 through December 2025. One hundred consecutive adults with objectively confirmed ALI and imaging-confirmed ischemic stroke were enrolled. Laboratory assessment included selected inherited and acquired thrombophilic abnormalities. Multivariable logistic regression was used to identify independent clinical factors associated with a hypercoagulable disorder. Results The study included 100 patients with a mean age of 56.8 ± 11.4 years, of whom 62 (62.0%) were female subjects. At least one selected hypercoagulable or prothrombotic abnormality was identified in 39 (39.0%) patients. Antiphospholipid syndrome (APS) was the most frequently identified abnormality, occurring in 18 (18.0%) patients, followed by hyperhomocysteinemia in 12 (12.0%), protein S deficiency in two (2.0%), protein C deficiency in three (3.0%), antithrombin III deficiency in two (2.0%), factor V Leiden mutation in three (3.0%), and prothrombin G20210A mutation in one (1.0%). Patients with a selected hypercoagulable or prothrombotic abnormality were younger than those without one (53.7 ± 9.8 vs. 58.8 ± 11.2 years; p=0.019) and were more frequently female (29/39 (74.4%) vs. 33/61 (54.1%); p=0.041). Previous ischemic stroke, previous venous thromboembolism (VTE), and Rutherford class IIb/III ALI were also more frequent among patients with a selected abnormality. Rutherford class IIb/III ALI was present in 27/39 (69.2%) patients with a selected abnormality compared with 20/61 (32.8%) patients without one (OR, 4.61; 95% CI, 1.94-10.95; p<0.001). In multivariable analysis, age <60 years (adjusted OR, 2.84; 95% CI, 1.16-6.91; p=0.022), female sex (adjusted OR, 2.18; 95% CI, 1.01-4.74; p=0.047), previous VTE (adjusted OR, 3.91; 95% CI, 1.29-11.84; p=0.016), and Rutherford class IIb/III ALI (adjusted OR, 2.86; 95% CI, 1.15-7.10; p=0.024) were independently associated with the presence of a selected hypercoagulable or prothrombotic abnormality. Conclusion Hypercoagulable abnormalities were identified in 39 (39.0%) patients presenting with concomitant ALI and ischemic stroke, with APS being the most frequently identified abnormality. Younger age, female sex, previous VTE, and more severe ALI were independently associated with a hypercoagulable state. These findings support selective thrombophilia evaluation in appropriately selected patients rather than routine testing of all patients with arterial thrombosis.