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We preformed a MEDLINE search to identify controlled studies published during 1966-1999 that reported the prevalence of deficiencies of protein C, protein S, antithrombin III, plasminogen, activated protein C resistance (APCR)/factor V Leide n mutation (FVL), anticardiolipin antibodies (ACL), or lupus anticoagulant (LA) in patients with ischemic stroke. The cumulative prevalence rates (pretest probabilities) and positive likelihood ratios for all studies and for those including only patients aged =50 years were used to calculate posttest probabilities for each coagulopathy, reflecting diagnostic yield. The cumulative pretest probabilities of coagulation defects in ischemic stroke patients are as follows: LA, 3% (8% for those aged =50 ye ars); ACL, 17% (21% for those aged =50 years); APCR/FVL, 7% (11% for those aged =50 years); and prothrombin mutation, 4.5% (5.7% for those aged =50 years). The posttest probabilities of ACL, LA, and APCR increased with increasing pretest probabilit y, the specificity of the tests, and features of the patients' history and clinical presentation. The pretest probabilities of coagulation defects in ischemic stroke are low. The diagnostic yield of coagulation tests may be increased by using tests with the highest specificities and by targeting patients with clinical of historical features that increase pretest probability. Consideration of these data might lead to more rational ordering of tests and an associated cost savings. |
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