ABSTRACT NUMBER: ESOC2026A988 SEX DIFFERENCES IN UTILIZATION OF HYPERCOAGULABILITY TESTING AFTER ISCHEMIC STROKE: A POPULATION-BASED STUDY

Abstract Background and aims Hypercoagulability can be a cause of ischemic stroke, particularly in cases without another clear etiology. There are limited guidelines to standardize the use of hypercoagulable testing in stroke workups. This introduces potential variability and bias in patient selection for testing. This study seeks to examine if sex differences exist in the utilization of hypercoagulable testing in a population-based study of patients following an ischemic stroke. Methods We ascertained all ischemic strokes in the 5-county area surrounding a Midwestern US city in calendar year 2020. Cases were identified by ICD codes, abstracted by study nurses, and physician adjudicated. When hypercoagulable testing was noted, testing details were physician confirmed prior to statistical analysis. To assess possible sex differences, we used Chi-square tests for categorical variables and Wilcoxon rank sum test for continuous variables. Logistic regression models were used to determine whether sex differences were present after adjusting for age, race, stroke subtype, and prespecified comorbidities including hypertension, patent foramen ovale, and drug use. Results Among 3,288 ischemic strokes in this population, 202 (6%) underwent hypercoagulability testing. Of those tested, 58% were female, with a younger median age than males (49 vs. 55 years, p=0.02). Logistic regression demonstrated that women were more likely to undergo testing than men (OR 1.49, 95% CI 1.09–2.04, p=0.01), independent of age, race, stroke subtype. Conclusions Women in our study were significantly more likely to undergo hypercoagulability testing. Future research is needed to determine whether sex-based differences in testing lead to differences in diagnostic yield, management decisions, or outcomes. Conflict of interest Kaylea Feldman: nothing to disclose. GCNKSS study team: the GCNKSS is supported by funding from the NIH NINDS (R01NS30678). Robert Stanton: nothing to disclose. Table 1 - belongs to Results Table 2 - belongs to Results Table 3 - belongs to Results