title: Inherited thrombophilia in ischemic stroke and its pathogenic subtypes.
abstract: OBJECTIVE
  One or more of the inherited thrombophilias may be causal risk factor for a proportion of ischemic strokes, but few studies have addressed this association or the association between thrombophilia and pathogenic subtypes of stroke.
  
  
  METHODS
  We conducted a case-control study of 219 hospital cases with a first-ever ischemic stroke and 205 randomly selected community control subjects stratified by age, sex, and postal code. With the use of established criteria, cases of stroke were classified by pathogenic subtype in a blinded fashion. The prevalence of conventional vascular risk factors; fasting plasma levels of protein C, protein S, antithrombin III; and genetic tests for the factor V Leiden and the prothrombin 20210A mutation were determined in cases and control subjects.
  
  
  RESULTS
  The prevalence of any thrombophilia was 14.7% (95% CI, 9.9% to 19.5%) among cases and 11.7% (95% CI, 7.4% to 17.0%) among control subjects (OR, 1.3; 95% CI, 0.7% to 2.3%). The prevalence of individual thrombophilias among cases ranged from 0.9% (95% CI, 0.1% to 3.4%) for protein S deficiency to 5.2% (95% CI, 0.3% to 9.1%) for antithrombin III deficiency; among control subjects, the prevalence ranged from 1.0% (95% CI, 0.1% to 3.6%) for protein S deficiency to 4.1% (95% CI, 0.2% to 7.8%) for antithrombin III deficiency. There were no significant differences in the prevalence of thrombophilia between cases and control subjects or between pathogenic subtypes of ischemic stroke.
  
  
  CONCLUSIONS
  One in 7 patients with first-ever acute ischemic stroke will test positive for one of the inherited thrombophilias, but the relation is likely to be coincidental rather than causal in almost all cases, irrespective of the pathogenic subtype of the ischemic stroke. These results suggest that routine testing for thrombophilia in most patients with acute ischemic stroke may be unnecessary. Whether the thrombophilias may still be important in younger patients with ischemic stroke or in predicting complications (eg, venous thrombosis) and stroke outcome remains uncertain.
authors.affiliation: Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia.
authors.forename: G J
authors.initials: GJ
authors.lastname: Hankey
authors.forename: J W
authors.initials: JW
authors.lastname: Eikelboom
authors.forename: F M
authors.initials: FM
authors.lastname: van Bockxmeer
authors.forename: E
authors.initials: E
authors.lastname: Lofthouse
authors.forename: N
authors.initials: N
authors.lastname: Staples
authors.forename: R I
authors.initials: RI
authors.lastname: Baker
mesh_terms: D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D020152:Antithrombin III Deficiency / Q000097:blood / Q000453:epidemiology; D002545:Brain Ischemia / Q000097:blood / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D018455:Protein S Deficiency / Q000097:blood / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000145:classification* / Q000453:epidemiology*; D019851:Thrombophilia / Q000097:blood / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D014904:Western Australia / Q000453:epidemiology
chemical_list: D011486:Protein C; D017293:Protein S; D000990:Antithrombin III