Clinical profile, common thrombophilia markers and risk factors in 47 young patients with ischemic stroke

Abstract

Introduction: Stroke is one of the most common causes of death worldwide, along with cardiovascular pathology and oncology. Hereditary or acquired thrombophilia is often associated with arterial-venous thrombosis. Ischemic stroke caused by thrombophilia has an incidence of approximately 1-4% of total cerebral vascular accidents, with a higher incidence in the period from 45 years old, representing a deficiency of antithrombin, protein C, protein S, factor mutations V Laiding, and associated risk factors. Purpose and objectives: In the period 2008-2012, a retrospective study was conducted on 47 patients, who have been identified and treated at the county hospital "Nicolae Oblu" from Iasi, Romania. Arterial thrombosis may occur as a result o f hereditary or acquired thrombophilia associated with an increase o f fibrinogen and dyslipidemia levels, along withthe risk factors. Materials and methods: O f the study was to identify the prevalence o f thrombophilia associated to the risk factors, present in case o f 47 patients, who experienced at least one episode o f arterial thrombosis. Forty-seven patients from Iasi, older than 45 years, who had at least one episode of ischemic stroke, were studied for three markers of thrombophilia (protein C, protein S and antithrombin III), the plasma levels of fibrinogen and lipoproteins, and risk factors. There were used basic methods of coagulation and the Clauss method for fibrinogen determination. This study included patients who experienced at least one episode of arterial thrombosis until the age of 45 years. Two patients, who are 47 and 50 years old, were included in the study because of the fact that the first episode of ischemic stroke occurred when they were younger than 45 years. We have also taken into account the presence of risk factors, such as smoking, dyslipidemia, family history, etc. The study excluded the patients younger than 45 years, and also other causes of hypercoagulability such as hypertension, liver disease, nephritic syndrome, malignancy, polycythemia, thrombocytosis, contraceptive use, hormone replacement, etc. Results: There were 47 patients (M / F 18/29) with an average age of 35.6 years (ranging from 18 to 50 years). From a total of 47 patients, 35 had their first episode of stroke, and 12 experienced at least the second one. 21 of the patients showed no abnormalities of the anticoagulation factors, 5 patients had protein C deficiency, 8 of them had protein S deficiency, 5 of them had an antithrombin III deficiency, 11 patients showed increased levels of fibrinogen, and 8 patients had dyslipidemia. Concerning the risk factors, 18 patients were smokers and 6 patients had a family history of arterial thrombotic accidents. A combination of thrombophilia markers and risk factors was seen in case of 24 of the 47 patients. The prevalence of risk factors: smoking 40%, the increased levels of fibrinogen and lipoprotein, about 17%, and family history 12%. Only two patients have shown a deficiency of anticoagulation markers in case of an experienced episode of cerebral-arterial thrombosis. Conclusion: The routine testing of fibrinogen could have a positive influence on the early recognition of young patients, who experienced an episode of cerebral-arterial thrombosis, recognition for the deficit of anticoagulation factors, since the presence of thrombophilia markers alone can very rarely be a factor for an ischemic stroke.