title: Thrombophilic screening in young patients (< 40 years) with idiopathic ischemic stroke: a controlled study.
abstract: BACKGROUND
  Despite extensive clinical and laboratory investigations, the etiology of ischemic stroke remains unknown in approximately one third of patients.
  
  
  METHODS
  Thirty-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.
  
  
  RESULTS
  Antithrombin 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).
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Thrombosis Center, Department of Biotecnologie Cellulari ed Ematologia, University Sapienza, Rome, Italy. dragonifrancesco@hotmail.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Dragoni
authors.forename: Flavia
authors.initials: F
authors.lastname: Chiarotti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosano
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
authors.forename: Daniela
authors.initials: D
authors.lastname: Tormene
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Mazzucconi
authors.forename: Arturo
authors.initials: A
authors.lastname: Cafolla
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Avvisati
mesh_terms: D000293:Adolescent; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood; D000991:Antithrombins / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D011486:Protein C / Q000378:metabolism; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000235:genetics*; D019851:Thrombophilia / Q000097:blood* / Q000235:genetics*; D055815:Young Adult
chemical_list: D017152:Antibodies, Antiphospholipid; D000991:Antithrombins; D011486:Protein C; D042965:Methylenetetrahydrofolate Reductase (NADPH2)