title: Factor V Leiden and prothrombin gene mutation may predispose to paradoxical embolism in subjects with patent foramen ovale.
abstract: The role of paradoxical embolism through patent foramen ovale as a mechanism of cryptogenic stroke is controversial. If a venous source of emboli is relevant, prothrombotic states should be associated with patent foramen ovale and cryptogenic stroke. We assessed the occurrence of several prothrombotic states (factor V Leiden, prothrombin G20210A, deficiencies in protein S, protein C and antithrombin, lupus anticoagulant, anticardiolipin antibodies, elevated factor VIII, resistance to activated protein C) and classical risk factors for venous thrombosis in 57 adult patients with cryptogenic stroke and patent foramen ovale and in 104 matched controls. Prothrombotic states [odds ratio (OR) 2.8; 95% confidence interval (CI), 1.2-6.5; P = 0.021], migraine with aura (OR 4.4; 95% CI 1.8-10.8; P = 0.001) and classical risk factors for venous thrombosis (OR 2.5; 95% CI 1.1-5.7; P = 0.037) were independent risk factors for cryptogenic stroke. In particular factor V Leiden or prothrombin G20210A associated with cryptogenic stroke (P = 0.022) whereas other coagulation abnormalities did not (P = 0.140). Among the patients with prothrombotic states, Valsalva manoeuvre was common at onset of stroke. Our results support the possibility of paradoxical embolism behind strokes in patients with patent foramen ovale.
authors.affiliation: Department of Neurology, Oulu University Central Hospital, Box 25, FIN 90029 Oulu, Finland. vesa.karttunen@oulu.fi
authors.forename: Vesa
authors.initials: V
authors.lastname: Karttunen
authors.forename: Leena
authors.initials: L
authors.lastname: Hiltunen
authors.forename: Vesa
authors.initials: V
authors.lastname: Rasi
authors.forename: Elina
authors.initials: E
authors.lastname: Vahtera
authors.forename: Matti
authors.initials: M
authors.lastname: Hillbom
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D019320:Embolism, Paradoxical / Q000209:etiology / Q000235:genetics*; D005165:Factor V / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D006344:Heart Septal Defects, Atrial / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000150:complications; D009154:Mutation; D011516:Prothrombin / Q000235:genetics*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000235:genetics; D019851:Thrombophilia / Q000150:complications
chemical_list: C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin