Do you always initiate hypercoagulable work up in a patient with recurrent stroke?

As always, this is a more complex problem than it appears. A history of both prior other thrombosis and family history of thrombosis is essential. Are there good reasons for the stroke and/or has it been worked out in past including carotid disease, atrial fibrillation, underlying malignancy, valvular disease, drug use, or autoimmune disorder? Has thrombotic microangiopathy been ruled out? Is the patient young and a history of sickle cell trait or sickle cell disease been looked for? Is the patient a female and have they been on oral contraceptives or a male with testosterone use? In general, we look for antiphospholipid syndrome and malignancy, but only evaluate antithrombin deficiency with family history and in a young person. MTHFR mutat...