Background. Heightened levels of Factor VIII (FVIII) have been associated with both arterial and venous thrombosis. While elevated FVIII is common during acute ischemic stroke (AIS), whether elevated FVIII confers an increased risk for recurrent thrombotic events (RTEs) following AIS has not been previously explored. Methods. Consecutive AIS patients who presented to our center between July 2008 and September 2013 and had FVIII measured during admission were identified from our stroke registry. Baseline characteristics and the occurrence of RTE (recurrent or progressive ischemic stroke, DVT/PE, and MI) were compared in patients with and without elevated FVIII levels. Results. Of the 298 patients included, 203 (68.1%) had elevated FVIII levels. Patients with elevated FVIII had higher rates of any in-hospital RTE (18.7% versus 8.4%, ). This association remained after adjustment for baseline stroke severity and etiology (OR 1.01, 95% CI 1.00–1.01, ). Rates of major disability were also higher in patients who experienced a RTE (17.8% versus 3.2%, ). Conclusion. A significantly higher frequency of in-hospital RTEs occurred in AIS patients with elevated FVIII. The occurrence of such events was associated with higher morbidity. Further study is indicated to evaluate whether FVIII is a candidate biomarker for increased risk of RTEs following AIS. 1. Introduction The procoagulant Factor VIII (FVIII) plays an important role in the activation of thrombin and ultimately in the formation of a fibrin-rich thrombus. Elevated plasma levels of FVIII have been previously associated with an increased risk of both venous [1–3] and arterial thrombotic events [4–7]. Elevated plasma levels of FVIII have been found to be common in patients with acute ischemic stroke (AIS) [6, 7], one of the leading causes of death and significant long-term disability worldwide [8]. Previous prospective work has found plasma FVIII levels to be one of the strongest hemostatic predictors of ischemic stroke occurrence [6]. More recent research has demonstrated elevated levels of plasma FVIII to be present in approximately 70% of patients with AIS during hospital admission, suggesting further that elevated FVIII levels are common during the acute phase of ischemic stroke [7]. FVIII has also been shown to be associated with other thromboembolic conditions known to complicate the course of AIS, such as deep vein thrombosis (DVT) [2], pulmonary embolism (PE) [3], and myocardial infarction [4, 5] in several different patient populations. Despite evidence suggesting an association between elevated FVIII
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