Abstract 27: Biomarkers of Coagulation and Hemostatic Activation in the Post-Acute Period Effectively Rule Out Hypercoagulable States in Patients With Embolic Stroke of Undetermined Source

Abstract

Introduction: We previously reported that markers of coagulation and hemostatic activation (MOCHA) have been associated with malignancy, venous thromboembolism (VTE) and hypercoagulable states in embolic stroke of undetermined source (ESUS) patients. The objective of our study was to identify independent predictors of these endpoints. Methods: Consecutive ESUS patients seen at the Emory Clinic from January 1, 2017 to June 30, 2019 underwent a MOCHA profile (d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) and were followed prospectively for new diagnoses of malignancy, VTE, other defined hypercoagulable states and the composite outcome. Abnormal MOCHA was defined as ≥ 2 elevated markers. Multivariable analyses were performed to identify predictors of the composite outcome. Results: Of 188 patients (mean age 63 ±16 years, 59% female, 50% Caucasian) included in the study period, 25 (13%) had the composite outcome. The median time between ESUS to MOCHA testing was 45 days (IQR 23-88). Abnormal MOCHA profile was the only independent predictor of the composite outcome (OR 2.34, 1.64-3.32, p<0.001) (AUC 0.824); age, sex, race, any history of tobacco use, hypertension, diabetes, history of stroke, cortical stroke, migraine, and left atrial size were not predictive. Abnormal MOCHA had a 96% sensitivity, 32% positive predictive value and 99% negative predictive value for the composite outcome. Conclusions: This study confirms that a normal MOCHA profile in the post-acute time period can rule out ESUS patients with malignancy, VTE or other underlying hypercoagulable states.