Ischemic Stroke Subtypes and Thrombophilia in Young and Elderly Brazilian Stroke Patients Admitted to a Rehabilitation Hospital

Carod-Artal, Francisco Javier; Nunes, Simone Vilela; Portugal, Dalton; Silva, Tania Virginia Fernandes; Vargas, Antônio Pedro

doi:10.1161/01.str.0000177881.34840.cf

Cited by 24 publications

(20 citation statements)

References 8 publications

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“…These studies also produced conflicting results, with some studies suggesting an association between PTM or FVL and PFO, 24,[41][42][43] and others finding no relation. 21,[37][38][39][40] None of the studies that examined PC, PS, or AT found any association of these deficiencies with PFO and stroke. [37][38][39][40]42 No study has evaluated the utility of warfarin vs antiplatelets for patients with PFO and thrombophilia.…”

Section: Inherited Thrombophilia and Patent Foramen Ovalementioning

confidence: 99%

“…21,[37][38][39][40] None of the studies that examined PC, PS, or AT found any association of these deficiencies with PFO and stroke. [37][38][39][40]42 No study has evaluated the utility of warfarin vs antiplatelets for patients with PFO and thrombophilia. One small study of 72 patients referred for PFO closure found no difference in recurrent stroke at 6 months in patients with or without thrombophilia.…”

Section: Inherited Thrombophilia and Patent Foramen Ovalementioning

confidence: 99%

“…Without limitation to the number of subjects, we identified 9 case-control studies examining the relationship of the inherited thrombophilias, patent foramen ovale (PFO), and stroke 21,24,[37][38][39][40][41][42][43] (Table 3). Sastry et al 9 collected data on both PFO and thrombophilia in ischemic stroke but did not evaluate them in relation to each other.…”

Section: Inherited Thrombophilia and Patent Foramen Ovalementioning

confidence: 99%

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Testing for Inherited Thrombophilias in Arterial Stroke

Morris¹,

Singh²,

Fisher³

2010

Stroke

109

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Background and Purpose-Despite a paucity of evidence supporting a true association of ischemic stroke and the inherited thrombophilias, it is common practice for many neurologists to order these tests as part of the work-up of ischemic stroke, especially in young patients. Treatment with oral anticoagulation is often used in patients with positive results for the inherited thrombophilias. Methods-We reviewed the literature focusing on case-control studies of the 5 most commonly inherited disorders of coagulation: protein C deficiency, protein S deficiency, antithrombin deficiency, and the factor V Leiden and prothrombin gene mutations in patients with stroke. We also analyzed the available data on stroke patients with inherited thrombophilia and patent foramen ovale. Results-Multiple case-control studies have not convincingly shown an association of the inherited thrombophilias with ischemic stroke, even in young patients and patients with patent foramen ovale. Conclusion-If there is an association between the inherited thrombophilias and arterial stroke, then it is a weak one, likely enhanced by other prothrombotic risk factors. The consequences of ordering these tests and attributing causality to an arterial event can result in significant costs to the health care system and pose a potential risk to patients, because this may lead to inappropriate use of long-term oral anticoagulants, exposing patients to harm without a clearly defined benefit. (Stroke. 2010;41:2985-2990.)Key Words: blood coagulation disorders Ⅲ inherited Ⅲ foramen ovale Ⅲ patent Ⅲ stroke Ⅲ thrombophilia P atients with inherited thrombophilias are known to be at increased risk for venous thromboembolism (VTE), but a causal relationship with arterial thrombosis has not been clearly established. The data supporting thrombophilias as a cause of arterial stroke are limited predominantly to case reports and uncontrolled studies with mixed results from meta-analyses. Case-control studies do not consistently support an association of these disorders with stroke. Despite many authorities stating that these tests should not be ordered routinely in the work-up of ischemic stroke, 1-3 many books and articles continue to perpetuate the need to order these tests as part of the stroke work-up, especially in the young. 4,5 We review the current literature on the inherited thrombophilias in ischemic arterial stroke, present a cost and risk-benefit analysis, and suggest when testing should be considered. Materials and MethodsThe PubMed and Ovid Medline databases from 1950 to present were searched using "stroke" combined with the following key words: "thrombophilia," "protein C deficiency," "protein S deficiency," "antithrombin III deficiency," "factor V Leiden," and "prothrombin gene mutation." Additional searches with these terms and "patent foramen ovale" were also performed. Limits of human and English language were imposed, although if abstracts could be obtained in English they were included. All results were searched for relevant data and divided into ca...

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Section: Inherited Thrombophilia and Patent Foramen Ovalementioning

confidence: 99%

Section: Inherited Thrombophilia and Patent Foramen Ovalementioning

confidence: 99%

Section: Inherited Thrombophilia and Patent Foramen Ovalementioning

confidence: 99%

See 1 more Smart Citation

Testing for Inherited Thrombophilias in Arterial Stroke

Morris¹,

Singh²,

Fisher³

2010

Stroke

109

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“…atrial fibrillation). In studies assessing the role of hereditary thrombophilia in the etiology of cerebral arterial and cerebral venous thrombosis (CAT, CVT), the risk for stroke was found to increase in the presence of different thrombophilic factors [9][10][11][12][13][14][15][16]. Hypercoagulable states are responsible for 5-10% of all IS cases, and hereditary thrombophilia is especially more common in the etiology of IS in the younger subgroup of patients [17].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of risk factors for thrombophilia in patients with cerebral venous thrombosis

Yokuş¹,

Balçık²,

Albayrak³

et al. 2010

Turk J Hematol

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Objective: The increased risk for thrombosis is known as hypercoagulability or thrombophilia. In our study, we aimed to determine the frequency of the identified defects for thrombophilia in patients with central venous thrombosis aged under 50 years and to compare results with the findings in the current literature. Materials and Methods: Forty-three patients (16-50 years old) were retrospectively evaluated. Thrombophilia investigation included determinations of protein C, protein S, antithrombin, and activated protein C resistance, factor V Leiden (FVL), prothrombin 20210A (PT 20210) and methylene tetrahydrofolate reductase (MTHFR) C677T mutations, antiphospholipid antibodies (APA), factor VIII levels, and homocysteine levels. Results: We detected a single thrombophilic defect in 67.4%, two defects in 27.9% and three defects in 4.7% of our patients. The most common thrombophilic defect was mutation in the MTHFR gene (41.8%), and this was followed by the FVL mutation (34.9%). Conclusion: Since the prevalence of individual thrombophilic defects varies in each population, ethnic group and geographical location, screening for thrombophilic defects in patients presenting with cerebral venous thrombosis should primarily investigate the most frequent thrombophilia risk factors. (Turk J Hematol 2010; 27: 162-7) Key words: Cerebral venous thrombosis, thrombophilia, thrombophilic defects Received: October 4, 2009 Accepted: March 22, 2010 Özet Amaç: Tromboz riskinin artması hiperkoagulabilite ya da trombofili olarak bilinmektedir. Çalışmamızda, serebral venöz tromboz gelişen ve trombofilik defekt saptanan 50 yaş ve altı hastalarımızda tespit edilen trombofilik defektleri, sıklığını değerlendirmek ve literatür bilgileriyle karşılaştırmak amaçlanmıştır.

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“…In Brazil, this genotype frequency is 14.9% and 11.8% in white individuals with stroke and without stroke, respectively; in black individuals, these frequencies are lower, being 10.3% and 1.9% in patients with stroke and without stroke, respectively 28 . According to Carod-Artal et al, 29 the thermolabile MTFHR genotype occurred in 5.05% and 10% of elderly and young individuals with stroke, respectively, admitted to a rehabilitation hospital. On the other hand, it has been shown that the frequency of this genotype is higher in Italy, 30 but paradoxically, cardiovascular complications are estimated to be relatively low.…”

Section: Discussionmentioning

confidence: 99%

Methylenetetrahydrofolate Reductase Gene Polymorphism Is Not Related to the Risk of Ischemic Cerebrovascular Disease in a Brazilian Population

Shinjo

Oba-Shinjo

Silva

et al. 2007

Clinics

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reductase gene polymorphism is not related to the risk of ischemic cerebrovascular disease in the a Brazilian population. Clinics. 2007;62(3):295-300. PURPOSE:Data are conflicting concerning the risk for ischemic stroke associated with a common polymorphism in the gene encoding 5,10-methylenetetrahydrofolate reductase C677T, which predisposes carriers to hyperhomocysteinemia. A meta-analysis study suggested that the 5,10-methylenetetrahydrofolate reductase 677TT genotype might have a small influence in determining susceptibility to ischemic stroke. METHODS: We analyzed the 5,10-methylenetetrahydrofolate reductase 677TT genotype polymorphism in Brazilian subjects with ischemic stroke, using a case-control design. RESULTS: We compared 5,10-methylenetetrahydrofolate reductase genotypes in groups of subjects presenting ischemic stroke (n = 127) and normal control (n = 126) and found an odds ratio of 1.97 (95% CI, 0.84-4.64) in a multivariate analysis in which results were adjusted to baseline clinical characteristics of study participants. CONCLUSION: We found that the homozygous 5,10-methylenetetrahydrofolate reductase C677T genotype was not a risk factor for ischemic stroke in these Brazilian subjects.

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Ischemic Stroke Subtypes and Thrombophilia in Young and Elderly Brazilian Stroke Patients Admitted to a Rehabilitation Hospital

Cited by 24 publications

References 8 publications

Testing for Inherited Thrombophilias in Arterial Stroke

Testing for Inherited Thrombophilias in Arterial Stroke

Evaluation of risk factors for thrombophilia in patients with cerebral venous thrombosis

Methylenetetrahydrofolate Reductase Gene Polymorphism Is Not Related to the Risk of Ischemic Cerebrovascular Disease in a Brazilian Population

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