This review will focus on recent developments in our understanding of cerebral venous and sinus thrombosis (CVST), as a side effect of combined oral contraceptives (COCs) use. Case-control studies have shown an increased risk of CVST in women who use COCs, especially third-generation contraceptives that contain gestodene or desogestrel. Several studies have indicated that the combination of COCs and thrombophilia greatly increased the risk of CVST, particularly in women with hyperhomocysteinaemia, factor V Leiden and the prothrombin-gene mutation. Women with thrombophilia who developed CVST while taking oral contraceptives should be definitively advised to stop using COCs. These patients should be considered for preventive therapy with low doses of heparin in prothrombotic situations such as bed rest or pregnancy, and the duration of anticoagulation should be considered on a case-by-case basis. Patients may be considered candidates for chronic treatment with antiplatelet agents. The best and most cost-effective screening method for thrombophilia in women who are planning to conceive is selective screening based on the presence of previous personal or family history of either prior extracerebral or cerebral venous thromboembolism events.

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

No abstract

Background:Factor V G1691A (FV Leiden), FII GA20210, and methylenetetrahydrofolate reductase (MTHFR) C677T mutations are the most common genetic risk factors for thromboembolism in the Western countries. However, there is rare data in Iran about cerebral venous and sinus thrombosis (CVST) patients. The aim of this study was to evaluate the frequency of common genetic thrombophilic factors in CVST patients.Materials and Methods:Forty consequently CVST patients from two University Hospital in Isfahan University of Medical Sciences aged more than 15 years from January 2009 to January 2011 were recruited. In parallel, 51 healthy subjects with the same age and race from similar population selected as controls. FV Leiden, FII GA20210, MTHFR C677T, and FV Cambridge gene mutations by polymerase chain reaction technique were evaluated in case and control groups.Results:FV Leiden, FII GA20210, and FV Cambridge gene mutations had very low prevalence in both case (5%, 2%, 0%) and control (2.5%, 0%, 0%) and were not found any significant difference between groups. MTHFR C677T mutations was in 22 (55%) of patients in case group and 18 (35.5%) of control group (P = 0.09).Conclusion:This study showed that the prevalence of FV Leiden, FII GA20210, and FV Cambridge were low. Laboratory investigations of these mutations as a routine test for all patients with CVST may not be cost benefit.

Background & Objectives: Previous studies showed left atrial volume index (LAVi) is a precise surrogate of atrial cardiopathy and associated with new-onset atrial fibrillation and embolic stroke undetermined source (ESUS). Recent data suggest that the left atrial functional index (LAFi) is associated with the risk of developing AF recurrence. However, there was no study to show LAFi in ESUS. We aim to compare the performance of different surrogates of atrial cardiopathy (LAVi and LAFi) in a cohort of ESUS patients and healthy adults. Methods: Between Dec 2018 to Feb 2020, consecutive patients diagnosed with ESUS and normal healthy controls (>18 years) were included. Left atrial diameter (LAD), left atrial diameter index (LADi), LAVi and LAFi were measured by transthoracic echocardiogram under American Society of Echocardiography guidelines. Results: A total of 125 patients (43 controls and 82 ESUS patients) were compared. Significant differences of LADi, LAVi, and LAFi were detected between ESUS and control (p=0.04, p=0.002, and p=0.001, respectively). On adjustment for age, sex, hypertension, and diabetes mellitus, LADi and LAVi the association with ESUS and LAFi (aOR decrease, 0.928; 95% CI 0.882–0.976; p = 0.004) remained significant and LAD, LADi, and LAVi were not associated with ESUS in this analysis. Conclusions: LAFi may be a more comprehensive predictor of atrial cardiopathy as compared to LADi and LAVi in risk stratification of ESUS or cryptogenic stroke.