A Model for Predicting Persistent Elevation of Factor VIII among Patients with Acute Ischemic Stroke

Abstract

Background and Purpose Elevated levels of coagulation factor VIII (FVIII) may persist independent of the acute-phase response; however, this relationship has not been investigated relative to acute ischemic stroke (AIS). We examined the frequency and predictors of persistently elevated FVIII in AIS patients. Methods AIS patients admitted between July 2008 and May 2014 with elevated baseline FVIII levels and repeat FVIII levels drawn for more than 7 days postdischarge were included. The patients were dichotomized by repeat FVIII level for univariate analysis at 150% and 200% activity thresholds. An adjusted model was developed to predict the likelihood of persistently elevated FVIII levels. Results Among 1616 AIS cases, 98 patients with elevated baseline FVIII had repeat FVIII levels. Persistent FVIII elevation was found in more than 75% of patients. At the 150% threshold, the prediction score ranged from 0 to 7 and included black race, female sex, prior stroke, hyperlipidemia, smoking, baseline FVIII > 200%, and baseline von Willebrand factor (vWF) level greater than 200%. At the 200% threshold, the prediction score ranged from 0–5 and included female sex, prior stroke, diabetes mellitus, baseline FVIII level greater 200%, and baseline vWF level greater than 200%. For each 1-point increase in score, the odds of persistent FVIII at both the 150% threshold (odds ratio [OR] = 10.4, 95% confidence interval [CI] 1.63–66.9, P = .0134) and 200% threshold (OR = 10.2, 95% CI 1.82–57.5, P = .0083) increased 10 times. Conclusion Because an elevated FVIII level confers increased stroke risk, our model for anticipating a persistently elevated FVIII level may identify patients at high risk for recurrent stroke. FVIII may be a target for secondary stroke prevention.

Elevated Factor VIII and von Willebrand Factor Levels Predict Unfavorable Outcome in Stroke Patients Treated with Intravenous Thrombolysis

“…Many studies have investigated the association between FVIII and/or VWF levels and the risk of cardiovascular or cerebrovascular events ( 8 , 9 , 12 , 36 ). Despite few conflicting results, it has been well established that elevated FVIII and/or VWF levels predispose patients to AIS ( 8 , 12 ).…”

Sex differences in predictors of ischemic stroke: current perspectives

“…Although FVIII has traditionally been viewed as an acute phase reactant, a recent study found that post-ischemic stroke, FVIII levels appear to remain elevated remote from index stroke in a majority of patients whose levels were elevated during the acute phase of ischemic stroke. 118 The study developed prediction models for determining which patients would experience persistently elevated FVIII at the two most commonly used activity thresholds, 150% and 200%. In both models, female sex was included as a predictor of persistent FVIII elevation.…”

Determining Subgroups of Significant Correlation in Analyzing Relation between NR2 Antibodies and Factor VIII in Acute Neurological Diseases

“…the higher the ABNR2 index, the less the activity of Factor VIII.) and existing views about the relationship between the levels of factor VIII or ATNR2 and the occurrence of a stroke [7,8,9,10]. An explanation of this phenomenon can be found in the publications [13,14], which show that the activation of FVIII causes the rapid appearance of antibodies (Factor VIII Inhibitors) that block its activity.…”

“…At the same time, the cause of stroke is the process of thrombus formation affected by the FVIII. Its connection to the stroke risk was noted in [9,10]. In this regard, it is of interest to study the relationship between the two indicators: ABNR2 and FVIII.…”