Abstract WP278: Markers of Coagulation and Hemostatic Activation in Embolic Stroke of Undetermined Source (ESUS) Patients With Patent Foramen Ovale

Abstract

Introduction: Recent randomized trials have shown that patent foramen ovale (PFO) closure combined with antiplatelet therapy in cryptogenic stroke patients ≤ 60 years of age is associated with a reduced risk of stroke compared to antiplatelet therapy alone, presumably by preventing a paradoxical embolism. The objective of this study was to evaluate the MOCHA profile, a sensitive marker of venous thromboembolism (VTE), in ESUS patients with PFO. Methods: Consecutive ESUS patients ≥ 18 years of age seen in the Emory Clinic from January 1, 2017 to June 30, 2018 underwent testing of MOCHA including serum d-dimer (DD), prothrombin fragment 1.2 (PTF1.2), thrombin-antithrombin (TAT) complex and fibrin monomer (FM). All patients were on antiplatelet therapy at the time of MOCHA testing and an abnormal MOCHA profile was defined as ≥ 2 elevated markers. We compared baseline characteristics and clinical outcomes between patients with and without PFO. Results: During the study period, 113 ESUS patients (mean age 64 +/- 15 years, 63% female, 54% non-white, 20% PFO) underwent MOCHA profile testing; 37 (32.7%) were ≤ 60 years of age. In the subgroup ≤ 60 years of age, the 11 (23%) PFO+ patients were younger (mean age 40 vs 46, p=0.009), more likely to be white (55% vs 35%, p=0.0001) and had higher ROPE score (median 8 vs 6, p=0.06) than PFO- patients. There was no significant difference between PFO+ and PFO- patients in the frequency of abnormal MOCHA (18% vs 19%), mean DD, PTF1.2, TAT, FM and frequency of VTE (1 event in each group). PFO+ and PFO- patients had a high frequency of migraine with aura (64%, 38%, p=0.15) and headache days in the month prior to stroke (mean 11 vs 5, p=0.72). In multivariable analysis of the overall cohort, age (OR 1.14 1.06-1.22 p<0.001) and ROPE score (OR 2.29 1.13-4.65 p=0.02) were significantly associated with abnormal MOCHA while PFO status (p=0.4) and migraine (p=0.23) were not. Conclusion: In ESUS patients ≤ 60 years of age, there was no difference in the MOCHA profile between PFO+ and PFO- patients. The high frequency of migraine with aura and headache days in the month prior to stroke regardless of PFO status needs further study to evaluate its role in young ESUS patients.