Clinical Factors Associated with Hypercoagulable and Prothrombotic Abnormalities in Patients with Acute Ischemic Stroke: A Prospective Observational Study

Abstract

Background:  Hypercoagulable and prothrombotic states may contribute to acute ischaemic stroke, particularly in younger patients and those with recurrent or otherwise unexplained thrombotic events. Aim: This study evaluated the frequency of selected hypercoagulable and prothrombotic laboratory abnormalities and identified clinical factors associated with their presence among patients with acute ischaemic stroke. Methods: This prospective observational study was conducted in the Department of Neurology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from January 2022 to December 2025. A total of 100 consecutive adults with imaging-confirmed acute ischaemic stroke were enrolled. The primary outcome was the presence of at least one predefined hypercoagulable or prothrombotic laboratory abnormality. Associations between clinical characteristics and the primary outcome were evaluated using univariable and multivariable logistic regression. Results: The mean age of the participants was 56.8 ± 11.4 years, and 62 (62.0%) were female. Hypertension was present in 69 (69.0%) patients, diabetes mellitus in 52 (52.0%), dyslipidaemia in 45 (45.0%), and current smoking in 37 (37.0%). Overall, 39 (39.0%) patients had at least one predefined hypercoagulable or prothrombotic laboratory abnormality. Antiphospholipid antibody abnormalities were identified in 18 (18.0%) patients and hyperhomocysteinaemia in 12 (12.0%). Patients with laboratory abnormalities were younger than those without abnormalities (53.7 ± 9.8 vs. 58.8 ± 11.2 years; p = 0.019), were more frequently female (74.4% vs. 54.1%; p = 0.041), and more frequently had previous venous thromboembolism (17.9% vs. 3.3%; p = 0.009). Severe neurological impairment, defined as NIHSS ≥15, was also more frequent among patients with abnormalities (41.0% vs. 19.7%; p = 0.019). In multivariable analysis, age <60 years (adjusted OR [aOR] 2.84, 95% CI 1.19–6.78; p = 0.022), female sex (aOR 2.18, 95% CI 1.01–4.72; p = 0.047), previous venous thromboembolism (aOR 3.91, 95% CI 1.29–11.82; p = 0.016), and NIHSS ≥15 (aOR 2.86, 95% CI 1.14–7.19; p = 0.024) were independently associated with the presence of a hypercoagulable or prothrombotic laboratory abnormality. Conclusion: Younger age, female sex, previous venous thromboembolism, and greater stroke severity were independently associated with these laboratory findings. These results support a clinically targeted rather than universal approach to thrombophilia evaluation in selected patients with ischaemic stroke. Because several thrombophilia assays may be affected by acute illness and anticoagulant therapy, abnormal findings obtained during the acute phase should be interpreted cautiously and confirmed after the acute event when clinically appropriate.