Objective:

To assess the utility of thrombophilia screening in determining candidacy for patent foramen ovale (PFO) closure for cryptogenic stroke patients <60 years old.

Background:

The predictive value of obtaining a hypercoagulable panel has been drawn into question, given its high cost and relatively low yield in altering clinical management. We report hypercoagulable panel findings and PFO closures in cryptogenic stroke patients < 60 with PFO to further assess the utility of thrombophilia screening in these patients.  

Design/Methods:

This was a single-center retrospective chart review of 52 patients under the age of 60 with cryptogenic stroke found to have a PFO on transesophageal echocardiogram (TEE). Clinical and demographic data were collected, including normalcy of the hypercoagulable panel and PFO closure status. Association between an abnormal hypercoagulable panel and PFO closure was assessed using a two-tailed t-test at ɑ < 0.05.  

Results:

A total of 45 patients underwent analysis. Hypercoagulable panel findings were abnormal in 25 patients (55.5%). These included abnormal levels of atherosclerotic markers which, given their transient nature, were deemed insignificant and were excluded from analysis (n=20). A remaining 5 patients had thrombophilic abnormalities. A total of 21 patients (46.7%) underwent PFO closure, 20 (95%) of whom had normal hypercoagulable panels. There was no significant difference in decision for PFO closure between patients with normal vs. abnormal panels (p=0.58). No evidence was found in documentation of PFO closure deferral due to abnormal hypercoagulable panel. 

Conclusions:

In young patients with cryptogenic stroke due to PFO, hypercoagulable panel findings were largely normal. Abnormalities noted were transient and did not alter the decision for PFO closure. This suggests that obtaining a hypercoagulable panel in this population may be low-yield and is a possible target for cost reduction.