Association between thrombophilia and ischemic stroke: when is work-up for hypercoagulable state indicated?

Hypercoagulable state or thrombophilia are disorders of the hemostatic mechanisms that increases the risk of thrombosis, both arterial and venous [1]. Inherited thrombophilia is a well-recognized risk factor for venous thrombosis, but its association with arterial thrombosis has not been clearly established. There are also various acquired conditions that are associated with hypercoagulable state. Case-control studies and meta-analyses investigating thrombophilia and ischemic stroke have not been consistent [2]. Despite lack of strong evidence in literature many clinicians order these tests as part of ischemic stroke work-up [3]. We report a case of cryptogenic stroke and review the challenges associated with the hypercoagulable state in such common clinical scenarios. We also review the evidence-based recommendations about the use of coagulation tests in the work-up for ischemic stroke.