Background

Potential causes of embolic stroke of undetermined source (ESUS) include occult malignancy, venous thrombosis (VTE) with paradoxical embolism, and hypercoagulable disorders. Given the association of markers of coagulation and hemostatic activation (MOCHA) with these causes, the objective of this study was to validate the utility of the MOCHA profile in identifying the underlying cause of stroke.

Methods

We prospectively identified ESUS patients from January 1, 2017 to December 1, 2019 who underwent MOCHA profile (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) testing. Abnormal MOCHA profile was defined as ≥ 2 abnormal markers. New diagnoses of malignancy, VTE, hypercoagulable disorders and recurrent stroke were identified during routine clinical follow-up.

Results

Of 236 ESUS patients, 104 (44%) patients had an abnormal MOCHA profile. In multivariable analyses the number of MOCHA abnormalities was significantly associated with malignancy, VTE, and hypercoagulable disorders (OR 2.59, CI 95% 1.78-3.76, p<0.001). Sensitivity, specificity, positive predictive value, and negative predictive value of an abnormal MOCHA profile for the combined outcome of malignancy, VTE, and hypercoagulability was 96%, 62%, 23%, and 99% respectively.

Discussion

The MOCHA profile was able to identify ESUS patients more likely to have malignancy, VTE, and hypercoagulable disorders during follow-up. Our results show that a normal MOCHA profile in ESUS patients can effectively rule out these potential causes of ESUS.

中文翻译：

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凝血和止血激活曲线标记物在不确定来源栓塞性卒中的管理中的实用性

背景

来源不明（ESUS）的栓塞性中风的潜在原因包括隐匿性恶性肿瘤，具有悖论性栓塞的静脉血栓形成（VTE）和高凝性疾病。考虑到凝血和止血激活（MOCHA）的标志物与这些原因相关，本研究的目的是验证MOCHA谱在确定中风的根本原因方面的实用性。

方法

我们从2017年1月1日至2019年12月1日前瞻性地鉴定了接受MOCHA分析（血浆d-二聚体，凝血酶原片段1.2，凝血酶-抗凝血酶复合物，纤维蛋白单体）的ESUS患者。MOCHA异常定义为≥2个异常标记。在常规临床随访期间，发现了新的恶性肿瘤，VTE，高凝性疾病和中风复发的诊断。

结果

在236名ESUS患者中，有104名（44％）患者的MOCHA谱异常。在多变量分析中，MOCHA异常的数量与恶性肿瘤，VTE和高凝性疾病显着相关（OR 2.59，CI 95％1.78-3.76，p <0.001）。MOCHA异常对恶性，VTE和高凝性综合结果的敏感性，特异性，阳性预测值和阴性预测值分别为96％，62％，23％和99％。

讨论区

MOCHA资料能够识别出在随访期间更可能患有恶性肿瘤，VTE和高凝性疾病的ESUS患者。我们的结果表明，在ESUS患者中正常的MOCHA谱可以有效排除这些可能的ESUS原因。