Abstract TP268: Markers of Coagulation and Hemostatic Activation in Ischemic Stroke Patients With Reduced Ejection Fraction on Antiplatelet Therapy

Introduction: Heart failure with reduced ejection fraction (HFrEF) is a risk factor for ischemic stroke. However, antithrombotic choice in a patient with HFrEF remains challenging. We set out to evaluate serum markers of coagulation and hemostatic activation (MOCHA) among ischemic stroke patients with HFrEF.

Methods: We performed a retrospective analysis of ischemic stroke patients with HFrEF (<40%) from July 28, 2017-June 13, 2023 seen at the Emory Stroke Clinic who underwent a MOCHA profile (serum D-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer) ≥2 weeks after the index stroke; abnormal MOCHA profile was defined as ≥2 elevated markers. We excluded patients who were on anticoagulation therapy at the initial visit.

Results: Overall, 40 patients (mean age 60 +/- 13.1, 53% female, 85% nonwhite) met criteria; median EF was 25% (IQR 15%-30%). Frequency of abnormal MOCHA profile was 43% in EF ≥25% and 58% in EF <25% (p = 0.52). No MOCHA components were associated with reduced EF in multivariate linear regression analysis (R2 = 0.03, p = 0.28). Over mean follow-up of 2.3 years, recurrent stroke occurred in 5.3 / 100 patient-years and major adverse cardiac events (MACE) occurred at 7.4 / 100 patient-years. Compared to patients with EF <25%, patients with EF ≥25% had higher recurrent stroke rates (6.46 vs 3.07 per 100 patient-years) and MACE (9.69 and 3.07 per 100 patient-years) Patients on antiplatelet regimens and anticoagulant regimens experienced MACE events at a rate of 4.25 and 10.62 per 100 patient-years, respectively. Patients with abnormal MOCHA profiles (n=20) had no recurrent strokes, but experienced other MACE events at a rate of 3.86 per 100 patient years, while patients with normal MOCHA profiles (n=20) experienced 11.73 MACE events per 100 patient-years, all of which were recurrent strokes.

Conclusion: In HFrEF patients with an ischemic stroke, the MOCHA profile was not associated with ejection fraction. No difference in recurrent stroke and MACE events was seen among patients with normal vs abnormal MOCHA profile.