Regular ArticleThrombophilic screening in young patients (< 40 years) with idiopathic ischemic stroke: A controlled study
Introduction
Cerebral ischemia is an emergent health problem especially in developed countries. In fact, approximately 80% of the burden of cerebrovascular disease stems from ischemic stroke, therefore preventive strategies have important public health implications [1], [2]. Moreover, ischemic stroke in young adults aged between 15 and 45 years old has a prevalence ranging from 3 to 5% [3], [4], [5]. However, despite extensive clinical and laboratory investigations, the etiology of cerebral thrombosis is complex and remains unknown in about one third of patients. The presence of primary hypercoagulability has been accurately investigated in patients with idiopathic ischemic stroke obtaining controversial results. In particular, two case reports and a family study have suggested a role for protein C (PC) [6], [7] and protein S (PS) [8] deficiency as a risk factor for cerebral ischemia. Retrospective evaluations have reported an association between focal ischemic stroke and the presence of antiphospholipid antibodies (APA) [9], [10]. This association has been confirmed in prospective controlled studies conducted in young patients [11], [12], [13], [14]. Other studies have evaluated the relationship between inherited thrombophilic risk factors such as F5 R506Q, F2 G20210A and the thermolabile variant C677T of methylenetetrahydrofolate reductase (MTHFR) and the development of ischemic stroke. The results from these studies revealed that these thrombophilic inherited factors may [15], [16], [17], [18] or may not [19], [20], [21], [22] have a role in the development of idiopathic ischemic stroke. As for mild hyperhomocysteinemia, whose blood levels are influenced by nutritional factors and daily vitamins intake, is actually considered an independent risk factor for peripheral, coronary and cerebral vascular disease [23], [24], [25], [26]. However, so far the role of inherited and acquired thrombophilic factors has been scarcely investigated in young patients with ischemic stroke. The aim of this study was to contemporaneously evaluate inherited and acquired thrombophilic factors in a cohort of young patients with a diagnosis of ischemic stroke in order to evaluate the role of these thrombophilic factors in the development of the disease.
Section snippets
Study population
Fifty-two consecutive patients with ischemic stroke were evaluated for inherited and acquired thrombophilic factors.
Inclusion criteria for entering this study were:
- 1)
Less than 40 years old;
- 2)
Presence of ischemic stroke diagnosed by computerized tomography scan and/or magnetic resonance;
- 3)
Normal cardiac structure and function;
- 4)
Absence of any heart malformations and disease;
- 5)
Absence of arrhythmias as assessed by clinical evaluation, electrocardiography and echocardiography in all patients;
- 6)
A normal
Results
Out of a total of fifty-two consecutive patients with documented ischemic stroke, 15 were over 40 years old and 3, less than 40 years old , had cardiac abnormalities. Therefore, a total of 34 patients (Males 13, Females 21, mean age 26.6 years, range 2-39) fulfilled the inclusion criteria and were prospectively evaluated. Their characteristics are reported in Table 1. As for conventional risk factors for arterial disease, 7/34 (20.6%) patients had a smoking habit, 1 (2.9%) had hyperlipidaemia and
Discussion
Idiopathic ischemic stroke is an important cause of death in general population and it is also emerging as a prominent health problem in developed countries [1], [2]. Therefore, the correct identification of risk factors related to the development of cerebral ischemia could have important social health implications. Genetic and environmental factors responsible for primary hypercoagulability have been associated to the development of idiopathic ischemic stroke. Indeed, these deficiencies are
Conflict of interest statement
The Authors declare the absence of any commercial or other associations that might pose a conflict of interest in connection with the submitted article. Moreover, the Authors declare that photographs of organs or body parts of the evaluated patients have not been used to perform this paper. This paper includes only new data which have not been published elsewhere and not under editorial consideration in another journal.
Acknowledgments
We would like to thank Mr. Michael Redante, 6015 Lower Mountain Rd., New Hope, PA, USA, for the revision of the English form of this manuscript.
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