Thrombophilias and Stroke: Diagnosis, Treatment, and Prognosis

Fields, Madeline; Levine, Steven R.

doi:10.1007/s11239-005-3205-5

Cited by 23 publications

(13 citation statements)

References 61 publications

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“…The ongoing prospective observational Polymorphisms and Risk of Ischemic Stroke (POLARIS) study is currently assessing the risk of a recurrent vascular event in patients with a recent ischemic stroke or TIA and genetic polymorphisms including FVL, PT and 5,10-methylentetrahydrofolate reductase mutation [20]. Despite this lack of evidence, current guidelines and review articles recommend considering anticoagulation as long-term secondary stroke prevention in adult ischemic stroke/TIA patients with a coagulopathy [1,9,21]. …”

Section: Discussionmentioning

confidence: 99%

“…In addition, coagulopathy screening was not performed in a central laboratory, and testing for coagulation protein deficiencies and antiphospholipid antibodies was not repeated after the acute ischemic event (i.e. 3 months later), which can result in the diagnosis of false-positive coagulopathies due to an acute phase response [9,22,23]. Data on previous deep vein thrombosis were only assessed in patients with a diagnosis of a coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

“…With the exception of stroke associated with antiphospholipid antibodies [5], no randomized controlled trials to date have compared anticoagulation with antiplatelet therapy in stroke patients with coagulation disorders. As a consequence, routine testing for coagulation disorders is not recommended [6,7], and thus the prevalence and prognosis of coagulopathies in adult ischemic stroke patients remain controversial [8,9]. …”

Section: Introductionmentioning

confidence: 99%

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Prognosis after Cryptogenic Cerebral Ischemia in Patients with Coagulopathies

Weber

Goertler²,

Benemann³

et al. 2009

Cerebrovasc Dis

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Background/Aim: Prognosis and optimal secondary prevention in ischemic stroke patients with coagulopathies remain unclear. The goal of this prospective observational multicenter study was to determine the risk of recurrence in cryptogenic stroke patients with either no or defined coagulopathies under various prevention regimens. Methods: A total of 429 patients from 14 German stroke centers with an acute cryptogenic ischemic stroke or transient ischemic attack in whom specialized coagulation testing for inherited and acquired coagulopathies (factor V Leiden mutation/resistance to activated protein C, prothrombin mutation, deficiencies of protein C, protein S, antithrombin III, anticardiolipin IgG antibodies, lupus anticoagulant) had been performed were included. Biannual follow-up in 339 (79%) of these patients assessed recurrent cerebrovascular events and secondary prevention therapy during a mean period of 2.5 years. Results: A defined coagulopathy was detected in 89 patients with follow-up, whereas no coagulopathy could be found in 250 patients with follow-up (control group). The Kaplan-Meier estimate for recurrent ischemic stroke or transient ischemic attack after 3 years was 13.6% (95% CI: 5.9–21.2%) in patients with a coagulopathy compared to 9.3% (95% CI: 5.4–13.2%) in controls, which was not significant after adjustment for potential risk factors by Cox regression analysis. Only a previous cerebrovascular ischemic event was an independent predictor for risk of recurrence in coagulopathy and control patients. Conclusions: Our observational data do not indicate a significantly increased risk for recurrent cerebrovascular events in cryptogenic stroke patients with a coagulopathy or any significant influence of the type of antithrombotic treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognosis after Cryptogenic Cerebral Ischemia in Patients with Coagulopathies

Weber

Goertler²,

Benemann³

et al. 2009

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…Only 1-4% of IS are related to acquired and genetic thrombophilias, but these numbers seem higher in young adults 44 . The most common acquired thrombophilia associated to IS in the young is antiphospholipid syndrome.…”

Section: Hematologic Conditionsmentioning

confidence: 94%

Ischemic stroke in young adults: an overview of etiological aspects

Yamamoto

2012

Arq. Neuro-Psiquiatr.

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Ischemic stroke (IS) in young adults is reported as uncommon, comprising less than 10% of all stroke patients 1 . However, In our clinical practice, we are faced not infrequently with patients aged less than 45 years who suffered a stroke, many of them with no risk factors for atherosclerosis and no ultimate clear etiological diagnosis even after a thorough investigation. This diagnostic challenge is one of the main scopes of studying and researching mechanisms of brain ischemia in young adults in addition to the dramatic personal, familial, and socio-economic consequences by affecting individuals at the top of their productive age.Although cardioembolism and cervicocephalic arterial dissection have been established as principal etiological factors of IS in young adults 2 , a systematic diagnostic approach must be applied to all patients, regarding the great number of potential causes in this group and the multifactorial nature in many of these patients.Despite more accurate diagnostic tools recently acquired in vascular imaging, hematological and genetic studies, currently, the number of young patients with cryptogenic IS remains high, performing 30-40% 3,4 . Considered an unusual cause of IS in the young two decades ago 5 , atherosclerosis has gaining projection by recent reports of significant raise in traditional risk factors as hypertension, diabetes, obesity, dyslipidemia and tabagism among hospitalized adolescents and young adults 6. Table 1 shows the main categorizations of etiologic subtypes of IS in young adults that must be considered in every young patient with IS. NoNAthERoSclERotIc ANgIopAthIES AbStRActStroke affects mainly people aged over 65 years, and atherosclerosis predominates as the main etiopathogenic factor in ischemic stroke (IS). On the other hand, cardiac embolism and arterial dissection are the most frequent causes of IS in patients aged less than 45 years. However, inappropriate control of traditional vascular risk factors in young people may be causing a significant increase of atherosclerosis-related IS in this population. Furthermore, a variety of etiologies, many of them uncommon, must be investigated. In endemic regions, neurocysticercosis and Chagas' disease deserve consideration. Undetermined cause has been still reported in as many as one third of young stroke patients.Key words: stroke, brain ischemia, young adult. RESumoA doença aterosclerótica é o fator etiopatogênico mais importante no acidente vascular cerebral isquêmico (AVCI), afecção que acomete predominantemente pessoas acima da sétima década de vida. Entretanto, nos adultos jovens a aterosclerose exibe frequência menor, sendo a embolia de origem cardíaca e as dissecções arteriais as causas mais comuns de AVCI em pacientes com até 45 anos de idade. Porém, o controle inadequado dos fatores de risco vascular nas faixas mais jovens da população pode estar levando à elevação significativa no nú-mero de infartos cerebrais associados à aterosclerose nessa faixa etária.Uma ampla gama de fatores etiológicos, muitos deles rar...

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“…Cardioembolism and cervicocephalic arterial dissection have been established as principal etiological factors of IS in young adults 2 , The proportion of cardioembolic strokes in young adults varies from 20% to one third 3,4. Considered an unusual cause of IS in the young two decades ago 5 , atherosclerosis has gaining projection by recent reports of significant raise in traditional risk factors as hypertension, diabetes, obesity, dyslipidemia and tabagism among hospitalized adolescents and young adults 6. Only 1-4% of IS are related to acquired and genetic thrombophilias, but these numbers seem higher in young adults 7 . The most common acquired thrombophilia associated to IS in the young is antiphospholipid syndrome.…”

Section: Introductionmentioning

confidence: 94%

A Case Report of Stroke in a Young Recreational Drug Abuser with Left Ventricular Apical Myxoma with Lupus Nephritis, Secondary Antiphospholipid Syndrome and Homocysteinemia

et al. 2017

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Abstract:In young adults 20%-47% cases of stroke is due to cardiac embolism. Cardiac Myxoma is an infrequent cause of embolic stroke in young. We are reporting a case of a ischemic stroke in a young adult of 34 years with a history of recreational drug use who was eventually diagnosed with Left Ventricular Apical Myxoma, Systemic Lupus Erythematous (SLE), Lupus Nephritis, Secondary Anti phospholipid Syndrome, Hyper homocysteinemia, and Dyslipidemia.

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Thrombophilias and Stroke: Diagnosis, Treatment, and Prognosis

Cited by 23 publications

References 61 publications

Prognosis after Cryptogenic Cerebral Ischemia in Patients with Coagulopathies

Prognosis after Cryptogenic Cerebral Ischemia in Patients with Coagulopathies

Ischemic stroke in young adults: an overview of etiological aspects

A Case Report of Stroke in a Young Recreational Drug Abuser with Left Ventricular Apical Myxoma with Lupus Nephritis, Secondary Antiphospholipid Syndrome and Homocysteinemia

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