Elevated Factor VIII Is Common in the Acute Phase of Ischemic Stroke and Is Associated with African American Race and Poor Outcomes (S43.007)

Abstract

Objective: We sought to characterize the relationship between factor VIII, patient characteristics, stroke severity, etiology, and early clinical outcomes in patients with acute ischemic stroke. Background Factor VIII drives the formation of fibrin rich clot. Elevation of factor VIII has been associated with higher risk of large vessel arterial occlusions. The relationship of factor VIII with etiology and outcomes in the acute phase of ischemic stroke is poorly understood. Design/Methods: We reviewed factor VIII levels in patients with acute ischemic stroke treated at our stroke center between July 2008 and April 2011. Factor VIII levels were considered elevated if exceeding the laboratory reference range: normal 0-150%. Baseline demographics, laboratory data, clinical course and outcome were compared in patients with normal or elevated levels. Spearman9s correlations were used to assess associations between factor VIII levels and collected variables. Results: Factor VIII level was elevated in 62% of the 73 patients. Significant correlations were found between factor VIII levels and African American race (0.37, p=0.001), hematocrit (-0.340, p=0.003), and platelet count (0.241, p=0.04), treatment with IV tPA (r=-0.24, p=0.041), length of stay (r=.307, p=0.009), discharge NIHSS (r=.338, p=0.004), discharge mRS (r=0.388, p=0.001), and poor discharge disposition (r=0.245, p=0.037). No relationship was found between factor VIII and baseline stroke severity or etiology. After adjusting for IV tPA use, new stroke on MRI, and race, factor VIII was a significant independent predictor of higher discharge NIHSS (p=0.016), higher mRS (p=0.025), and poor disposition (p=0.045). Conclusions: High factor VIII level, found in the majority of patients with acute ischemic stroke, was associated with poor early outcomes. Additional studies are required to determine if factor VIII is causal or a marker of poor outcome in patients with acute ischemic stroke and whether factor VIII contributes to the increased risk of stroke in African American patients. Disclosure: Dr. Chang has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Kruse-Jarres has nothing to disclose. Dr. Leissinger has nothing to disclose. Dr. Martin-Schild has nothing to disclose.