What is the utility of a hypercoagulability workup in recurrent cryptogenic stroke, and what specific tests would you recommend?
Ambulatory monitoring for AFib is probably more helpful than such a thorough clotting workup.
As the responses to this important question indicate, when evidence is inconclusive or existing treatments remain unsatisfactory, there is huge variation in practice. In general, however, the diagnostic yield of thrombophilia tests in unselected stroke patients is very low. This is not surprising as...
There is a 5% prevalence of Factor V Leiden among Caucasian Americans and ~1% among other ethnicities (Ridker et al, PMID 9109469). The cost and consequences of testing should be carefully thought out in the absence of other thromboses.
If the patient is over 50 then I usually wonder why we are getting consulted. I rarely order hereditary thrombophilia testing for this population, but invariably it is already performed by the time I see the patient, despite the reason for the consult stating "thrombophilia workup."
For VTE, where mo...
I agree with the above answers. My approach and types of hypercoag labs to order are patient dependent. In a younger patient (with and without PFO)- I complete the full hypercoagulable panel (including genetic testing) in conjunction with hematologist evaluation as well. If need be will also evaluat...
I would do a full hypercoagulable state work-up in a patient with two or more cryptogenic strokes, particularly in younger patients. This would include antiphospholipid antibodies, Protein C, S, Antithrombin III, and others.