Prognosis after Cryptogenic Cerebral Ischemia in Patients with Coagulopathies

Abstract

Background/Aim: Prognosis and optimal secondary prevention in ischemic stroke patients with coagulopathies remain unclear. The goal of this prospective observational multicenter study was to determine the risk of recurrence in cryptogenic stroke patients with either no or defined coagulopathies under various prevention regimens. Methods: A total of 429 patients from 14 German stroke centers with an acute cryptogenic ischemic stroke or transient ischemic attack in whom specialized coagulation testing for inherited and acquired coagulopathies (factor V Leiden mutation/resistance to activated protein C, prothrombin mutation, deficiencies of protein C, protein S, antithrombin III, anticardiolipin IgG antibodies, lupus anticoagulant) had been performed were included. Biannual follow-up in 339 (79%) of these patients assessed recurrent cerebrovascular events and secondary prevention therapy during a mean period of 2.5 years. Results: A defined coagulopathy was detected in 89 patients with follow-up, whereas no coagulopathy could be found in 250 patients with follow-up (control group). The Kaplan-Meier estimate for recurrent ischemic stroke or transient ischemic attack after 3 years was 13.6% (95% CI: 5.9–21.2%) in patients with a coagulopathy compared to 9.3% (95% CI: 5.4–13.2%) in controls, which was not significant after adjustment for potential risk factors by Cox regression analysis. Only a previous cerebrovascular ischemic event was an independent predictor for risk of recurrence in coagulopathy and control patients. Conclusions: Our observational data do not indicate a significantly increased risk for recurrent cerebrovascular events in cryptogenic stroke patients with a coagulopathy or any significant influence of the type of antithrombotic treatment.