Abstract
BackgroundActivated protein C (APC) resistance is the most common inherited prothrombotic disorder. The role of APC resistance in ischemic stroke is controversially discussed.ObjectivesThe 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/MethodsWe 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.ResultsA 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.ConclusionAPC-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.
Highlights
We retrospectively identified 966 patients who had had an ischemic stroke or transitory ischemic attack (TIA) and in whom laboratory tests for Activated protein C (APC) resistance had been conducted
Activated protein C (APC) resistance was first shown to be a possible cause for thrombophilia approximately 20 years ago
Dahlbäck et al observed that addition of APC to plasma of patients with multiple thrombotic events did not result in the expected prolongation of the coagulation time in an activated partial thromboplastin time assay [1]
Summary
Activated protein C (APC) resistance was first shown to be a possible cause for thrombophilia approximately 20 years ago. Studies yield conflicting results: some found individuals with APC resistance to be more likely to suffer from an ischemic stroke [7,8,9,10], others were not able to demonstrate any association [4, 11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30], and yet others only found associations in certain subgroups such as young patients or patients who had a cryptogenic stroke [31,32,33,34,35]. Editor: Giuseppe Pignataro, Universita degli Studi di Napoli Federico II, ITALY Received: March 31, 2016 Accepted: June 13, 2016 Published: August 10, 2016
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