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Original Paper

Prognosis after Cryptogenic Cerebral Ischemia in Patients with Coagulopathies

Weber R.a · Goertler M.b · Benemann J.a · Diener H.C.a · Weimar C.a

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Departments of Neurology,aUniversity of Duisburg-Essen, Essen, and bUniversity of Magdeburg, Magdeburg, Germany

Related Articles for ""

Cerebrovasc Dis 2009;28:611–617

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: March 05, 2009
Accepted: August 12, 2009
Published online: October 22, 2009
Issue release date: November 2009

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Background/Aim: Prognosis and optimal secondary prevention in ischemic stroke patients with coagulopathies remain unclear. The goal of this prospective observational multicenter study was to determine the risk of recurrence in cryptogenic stroke patients with either no or defined coagulopathies under various prevention regimens. Methods: A total of 429 patients from 14 German stroke centers with an acute cryptogenic ischemic stroke or transient ischemic attack in whom specialized coagulation testing for inherited and acquired coagulopathies (factor V Leiden mutation/resistance to activated protein C, prothrombin mutation, deficiencies of protein C, protein S, antithrombin III, anticardiolipin IgG antibodies, lupus anticoagulant) had been performed were included. Biannual follow-up in 339 (79%) of these patients assessed recurrent cerebrovascular events and secondary prevention therapy during a mean period of 2.5 years. Results: A defined coagulopathy was detected in 89 patients with follow-up, whereas no coagulopathy could be found in 250 patients with follow-up (control group). The Kaplan-Meier estimate for recurrent ischemic stroke or transient ischemic attack after 3 years was 13.6% (95% CI: 5.9–21.2%) in patients with a coagulopathy compared to 9.3% (95% CI: 5.4–13.2%) in controls, which was not significant after adjustment for potential risk factors by Cox regression analysis. Only a previous cerebrovascular ischemic event was an independent predictor for risk of recurrence in coagulopathy and control patients. Conclusions: Our observational data do not indicate a significantly increased risk for recurrent cerebrovascular events in cryptogenic stroke patients with a coagulopathy or any significant influence of the type of antithrombotic treatment.

© 2009 S. Karger AG, Basel


References

  1. Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T: Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Stroke 2006;37:577–617.
  2. Ho WK, Hankey GJ, Quinlan DJ, Eikelboom JW: Risk of recurrent venous thromboembolism in patients with common thrombophilia: a systematic review. Arch Intern Med 2006;166:729–736.
  3. Buller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE: Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126:401S–428S.
  4. Ost D, Tepper J, Mihara H, Lander O, Heinzer R, Fein A: Duration of anticoagulation following venous thromboembolism: a meta-analysis. JAMA 2005;294:706–715.
  5. Levine SR, Brey RL, Tilley BC, Thompson JL, Sacco RL, Sciacca RR, Murphy A, Lu Y, Costigan TM, Rhine C, Levin B, Triplett DA, Mohr JP: Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke. JAMA 2004;291:576–584.
  6. Bushnell CD, Goldstein LB: Diagnostic testing for coagulopathies in patients with ischemic stroke. Stroke 2000;31:3067–3078.
  7. Hankey GJ, Eikelboom JW: Editorial comment – routine thrombophilia testing in stroke patients is unjustified. Stroke 2003;34:1826–1827.
  8. Rahemtullah A, Van Cott EM: Hypercoagulation testing in ischemic stroke. Arch Pathol Lab Med 2007;131:890–901.
  9. Fields MC, Levine SR: Thrombophilias and stroke: diagnosis, treatment, and prognosis. J Thromb Thrombolysis 2005;20:113–126.
  10. Weimar C, Holle DN, Benemann J, Schmid E, Schminke U, Haberl RL, Diener HC, Goertler M: Current management and risk of recurrent stroke in cerebrovascular patients with cardiac right-to left-shunt. Cerebrovasc Dis 2009;28:349–356.
  11. Spannagl M, Dick A, Reinauer H: External quality assessment schemes in coagulation in Germany: between regulatory bodies and patient outcome. Semin Thromb Hemost 2007;33:259–264.
  12. Bushnell C, Siddiqi Z, Morgenlander JC, Goldstein LB: Use of specialized coagulation testing in the evaluation of patients with acute ischemic stroke. Neurology 2001;56:624–627.
  13. Bushnell CD, Goldstein LB: Physician knowledge and practices in the evaluation of coagulopathies in stroke patients. Stroke 2002;33:948–953.
  14. Botto N, Spadoni I, Giusti S, Ait-Ali L, Sicari R, Andreassi MG: Prothrombotic mutations as risk factors for cryptogenic ischemic cerebrovascular events in young subjects with patent foramen ovale. Stroke 2007;38:2070–2073.
  15. Slooter AJ, Rosendaal FR, Tanis BC, Kemmeren JM, van der Graaf Y, Algra A: Prothrombotic conditions, oral contraceptives, and the risk of ischemic stroke. J Thromb Haemost 2005;3:1213–1217.
  16. Pezzini A, Grassi M, Iacoviello L, Del Zotto E, Archetti S, Giossi A, Padovani A: Inherited thrombophilia and stratification of ischaemic stroke risk among users of oral contraceptives. J Neurol Neurosurg Psychiatry 2007;78:271–276.
  17. Kluft C, Lansink M: Effect of oral contraceptives on haemostasis variables. Thromb Haemost 1997;78:315–326.
  18. Haapaniemi E, Helenius J, Jakovljevic D, Soinne L, Syrjälä M, Kaste M, Lassila R, Tatlisumak T: Ischaemic stroke patients with heterozygous factor V Leiden present with multiple brain infarctions and widespread atherothrombotic disease. Thromb Haemost 2009;101:145–150.
  19. Strater R, Becker S, von Eckardstein A, Heinecke A, Gutsche S, Junker R, Kurnik K, Schobess R, Nowak-Gottl U: Prospective assessment of risk factors for recurrent stroke during childhood – a 5-year follow-up study. Lancet 2002;360:1540–1545.
  20. Pruissen DM, Kappelle LJ, Algra A: Polymorphisms and Risk of Ischemic Stroke (POLARIS) study: rationale and design. Eur Neurol 2004;51:30–34.
  21. de Moerloose P, Boehlen F: Inherited thrombophilia in arterial disease: a selective review. Semin Hematol 2007;44:106–113.
  22. Douay X, Lucas C, Caron C, Goudemand J, Leys D: Antithrombin, protein c and protein s levels in 127 consecutive young adults with ischemic stroke. Acta Neurol Scand 1998;98:124–127.
  23. Munts AG, van Genderen PJ, Dippel DW, van Kooten F, Koudstaal PJ: Coagulation disorders in young adults with acute cerebral ischaemia. J Neurol 1998;245:21–25.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: March 05, 2009
Accepted: August 12, 2009
Published online: October 22, 2009
Issue release date: November 2009

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED


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