Abstract T P169: The Questionable Cost-effectiveness of Hypercoagulable Testing in Arterial Ischemic Stroke

Introduction: Hypercoagulable states may be associated with arterial ischemic stroke, particularly in cryptogenic stroke and incidence in the young. Prior studies identify an association with arterial stroke of antiphospholipid antibody syndrome and hyperhomocysteinemia, possible association of Factor V Leiden and Prothrombin mutation, and little or no association of Protein C, Protein S, and Antithrombin III deficiencies. Little data exists regarding the cost-effectiveness of routine testing in selected cases. Hypothesis: Routine hypercoagulable testing at our institution rarely changes management and a selected testing approach is more cost-effective. Methods: Based on known associations of hypercoagulable states with acute ischemic stroke, we created a revised testing criteria to exclude states (1) primarily associated with venous occlusion and (2) unlikely to change medical management in secondary stroke prevention. As part of a quality assurance review, we retrospectively applied these criteria to 94 stroke patients who consecutively received the hypercoagulable panel over 2 years. Results: Assuming current costs of hypercoagulable testing at our institution, a potential $120,000 in health care costs could potentially have been saved with no additional diagnostic value and the same outcome on medical management for secondary stroke prevention. Conclusion: A selected testing criteria for hypercoagulable states in diagnosis of arterial ischemic stroke may be more cost effective. Further prospective study in select stroke cases is warranted.