Thrombophilic screening in young patients (< 40 years) with idiopathic ischemic stroke: a controlled study |
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Authors: | Dragoni Francesco Chiarotti Flavia Rosano Giuseppe Simioni Paolo Tormene Daniela Mazzucconi Maria Gabriella Cafolla Arturo Avvisati Giuseppe |
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Institution: | a Thrombosis Center, Department of “Biotecnologie Cellulari ed Ematologia”, University “Sapienza”, Rome, Italyb Department of “Biologia cellulare e Neuroscienze”, Istituto Superiore di Sanità, Rome, Italyc Department of “Medicina Interna”, IRCCS San Raffaele, Rome, Italyd Department of “Scienze Mediche e Chirurgiche”, University of Padua, Padua, Italye Hematology, University “Campus Bio-Medico”, Rome, Italy |
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Abstract: | IntroductionDespite extensive clinical and laboratory investigations, the etiology of ischemic stroke remains unknown in approximately one third of patients.Materials and MethodsThirty-four consecutive patients less than 40 years old (Males 13, Females 21, mean age 26.6 years, range 2-39) with documented ischemic stroke underwent, one year after the acute event, laboratory evaluation of antithrombin, protein C, free and total protein S, activated protein C resistance, fibrinogen, factor VII:C, homocysteine levels and antiphospholipid antibodies (APA). Moreover, prevalence of F5 R506Q, F2 G2021A and homozygosis for thermolabile variant C677T of the methylenetetrahydrofolate reductase (MTHFR) were also evaluated and compared to the results obtained in 120 normal controls.ResultsAntithrombin and protein C levels resulted normal in all cases. One patient (2.9%) showed free protein S deficiency and 3 patients (8.8%) had activated protein C resistance. Homocysteine levels above 15 μmol/L were found in one patient (2.9%). APA were found in 21 patients (61.7%) and in only 2 out of 120 (1.66%) controls (OR = 95.31; 95% C.I.: 18.22-667.81). The multivariate analysis selected that the presence of APA was significantly associated with an increased risk of stroke (OR = 156.60; 95% C.I.: 25.99-943.47) in this cohort of patients. The combination between APA and cardiovascular risk factors determined a risk of 29-fold (OR = 29.31; 95% CI: 3.28-261.69).DiscussionOur data suggest that the presence of APA is associated with an increased risk of idiopathic ischemic stroke in young patients. Furthermore, also the combination of APA and cardiovascular risk factors is significantly associated with development of idiopathic ischemic stroke. |
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Keywords: | ACA Anticardiolipin antibodies APA Antiphospholipid Antibodies AT Antithrombin dRVVT diluted Russel's Viper Venom Time ISTH International Society on Thrombosis and Haemostasis KCT Kaolin Clotting Time LA Lupus Anticoagulant MTHFR Methylenetetrahydrofolate Reductase OR Odds Ratio PPP Platelet-Poor Plasma PC Protein C PS Protein S |
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