Background

Young stroke patients (YSP) (≤50 years old) are often worked up extensively for numerous prothrombotic risk factors, the prevalence of which can differ significantly between Southeast Asian (SEA) and Caucasian populations. This study evaluates the effectiveness of the young stroke workup in the SEA population and identifies characteristics of patients with abnormal results, to guide future management of YSPs.

Methods

We retrospectively reviewed the records of 276 consecutive patients (≤50 years old) admitted to our hospital in Singapore between January 2016 and October 2017 for ischaemic stroke or transient ischaemic attack.

Results

Amongst our 276 patients, 64.9% were Chinese, 14.5% Malay, 12.7% Indian, and 8.0% Others. 
Tests most commonly positive were Antinuclear antibody (ANA) (10.9%) and elevated homocysteine (10.1%). None tested positive for Protein S (PS), antithrombin III (ATIII) deficiency or Lupus anticoagulant (LAC). Amongst those positive for ANA, 3 (10%) had co-existing autoimmune diseases. The only Protein C (PC) deficient patient had concurrent deep vein thrombosis and a patent foramen ovale. The one patient who tested positive for both Factor V Leiden and APC resistance was of Middle-Eastern origin and had a strong family history of stroke.

Conclusion

In our SEA population, ANA and homocysteine had the highest prevalence while FVL, PC, PS, ATIII and LAC had a low prevalence. To ensure cost-effectiveness, we should carefully select patients when performing these tests.

COST-EFFECTIVENESS OF THE YOUNG STROKE WORK-UP IN A SOUTHEAST ASIAN POPULATION