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Badescu MC, Butnariu LI, Costache AD, Gheorghe L, Seritean Isac PN, Chetran A, Leancă SA, Afrăsânie I, Duca ȘT, Gorduza EV, Costache II, Rezus C. Acute Myocardial Infarction in Patients with Hereditary Thrombophilia-A Focus on Factor V Leiden and Prothrombin G20210A. Life (Basel) 2023; 13:1371. [PMID: 37374153 DOI: 10.3390/life13061371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/21/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Factor V (FV) Leiden and prothrombin G20210A are the most common hereditary thrombophilias. While their role in venous thromboembolism is well known, there are still uncertainties regarding their relationship with arterial thrombotic events, especially coronary ones. Our research, based on an in-depth analysis of the available literature, provides up-to-date information on the relationship between FV Leiden and prothrombin G20210A and acute myocardial infarction. FV Leiden and prothrombin G20210A screening should be implemented only in select cases, such as acute coronary syndrome in young individuals and/or in the absence of traditional cardiovascular risk factors and/or in the absence of significant coronary artery stenosis at angiography. Their identification should be followed by the implementation of optimal control of modifiable traditional cardiovascular risk factors to reduce the risk of recurrent events and genotyping and genetic counseling of all family members of affected cases for proper prophylaxis. An extended dual antiplatelet therapy (DAPT) may be considered, given the lower risk of bleeding under DAPT conferred by FV Leiden.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- III Internal Medicine Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Lăcrămioara Ionela Butnariu
- Department of Mother and Child Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Liliana Gheorghe
- Department of Radiology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Radiology Clinic "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Petronela Nicoleta Seritean Isac
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- III Internal Medicine Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Adriana Chetran
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiology Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Sabina Andreea Leancă
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiology Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Irina Afrăsânie
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiology Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Ștefania-Teodora Duca
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiology Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Eusebiu Vlad Gorduza
- Department of Mother and Child Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Irina Iuliana Costache
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Cardiology Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- III Internal Medicine Clinic, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
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Factor V Leiden, Factor II, Protein C, Protein S, and Antithrombin and Ischemic Strokes in Young Adults: A Meta-Analysis. Genes (Basel) 2022; 13:genes13112081. [DOI: 10.3390/genes13112081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022] Open
Abstract
Ischemic strokes are one of the leading causes of death worldwide. The aim of this meta-analysis is to elaborate on the role of inherited predisposition to thrombophilia in the etiology of ischemic strokes in young adults. The keywords factor V Leiden (FVL), factor II, prothrombin (PT), protein C (PC), protein S (PS), antithrombin (AT), ischemic stroke, and young were used to search different databases. We selected studies with participants who were between 18 and 65 years. A total of 104 studies were eligible for inclusion in the meta-analysis. All the studied genetic markers were risk factors for ischemic stroke according to our results (FVL OR = 1.74; PT OR = 1.95; PC OR = 10.20; PS OR = 1.74; AT OR = 3.47; p < 0.05). There was moderate heterogeneity for most of the results, and subgroup analyses were conducted by dividing the studies according to the geographic location, gender ratio, and selection criteria of the performed study. There were no significant differences between the groups, but different geographic location was a probable source of heterogeneity. All of the studied markers—FVL, prothrombin, PC, PS, and AT—were significantly associated with increased risk of ischemic stroke in young adults and, if tested, could improve the quality of care.
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Alhazzani AA, Kumar A, Selim M. Association between Factor V Gene Polymorphism and Risk of Ischemic Stroke: An Updated Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 27:1252-1261. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/20/2017] [Accepted: 12/03/2017] [Indexed: 11/25/2022] Open
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Rios DRA, Alpoim PN, Godoi LC, Mendes FS, Lwaleed B, Sousa LP, Perucci LO, Carvalho MG, Borges KBG, Dusse LMS. Is there a link among thrombophilia factors and preeclampsia? J Thromb Thrombolysis 2017; 44:516-518. [DOI: 10.1007/s11239-017-1556-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sarecka-Hujar B, Kopyta I, Skrzypek M, Sordyl J. Association Between the 20210G>A Prothrombin Gene Polymorphism and Arterial Ischemic Stroke in Children and Young Adults-Two Meta-analyses of 3586 Cases and 6440 Control Subjects in Total. Pediatr Neurol 2017; 69:93-101. [PMID: 28160964 DOI: 10.1016/j.pediatrneurol.2016.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous data have shown that the 20210G>A polymorphism of the Factor II gene is related to an increased prothrombin level, which may in turn lead to a procoagulant state. The heterogeneous and multifactorial character of arterial ischemic stroke often results in contradictory reports describing the association between the 20210G>A polymorphism and arterial ischemic stroke in different populations. We performed a meta-analysis of available data addressing the relation between the FII 20210G>A polymorphism and arterial ischemic stroke, both in young adults and children. METHODS We searched PubMed using appropriate keywords. The inclusion criteria for the study were as follows: case-control study, study population consisting of children, study population consisting of young adults, arterial ischemic stroke confirmed by magnetic resonance imaging or computed tomography, and English language. The exclusion criteria included lack of genotype or allele frequencies, study design other than a case-control study, outcome definition other than arterial ischemic stroke, and previously overlapped patient groups. Finally, 30 case-control studies (14 in children and 16 in young adults) were included. Statistical analyses were conducted using R software. Heterogeneity between the studies was evaluated using the Dersimonian and Laird's Q test. In the case of significant between-studies heterogeneity, the pooled odds ratio was estimated with a random-effects model, otherwise a fixed-effects model was used. RESULTS The pooled analysis showed that carriers of 20210A allele (GA+AA genotypes) of the prothrombin gene are more common in arterial ischemic stroke patients, both in children and young adults, than in control subjects (P = 0.006; odds ratio, 1.83; 95% confidence interval, 1.19 to 2.80 and P = 0.001; odds ratio, 1.69; 95% confidence interval, 1.25 to 2.28, respectively). CONCLUSIONS The results of the present meta-analysis have proven that the FII 20210G>A polymorphism is associated with arterial ischemic stroke in both pediatric and young adult patients.
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Affiliation(s)
- Beata Sarecka-Hujar
- Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Ilona Kopyta
- Department of Paediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland.
| | - Michal Skrzypek
- Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
| | - Joanna Sordyl
- Department of Paediatrics and Paediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
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Van Cott EM, Khor B, Zehnder JL. Factor V Leiden. Am J Hematol 2016; 91:46-9. [PMID: 26492443 DOI: 10.1002/ajh.24222] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022]
Abstract
Factor V Leiden (FVLeiden ) is a common hereditary thrombophilia that causes activated protein C (APC) resistance. This review describes many of the most fascinating features of FVLeiden , including background features, mechanisms of hypercoagulability, the founder mutation concept, the "FVLeiden paradox," synergistic interaction with other thrombotic risk factors, the intertwined relationship between FVLeiden and APC resistance testing, and other, uncommon mutations implicated in causing APC resistance. In addition, there are several conditions where laboratory tests for APC resistance and FVLeiden are or can be discrepant, including lupus anticoagulants, anticoagulants such as direct thrombin inhibitors (dabigatran, argatroban, and bivalirudin) and rivaroxaban, as well as pseudohomozygous, pseudo-wildtype, liver transplant, and bone marrow transplant patients. The laboratory test error rate for FVLeiden is also presented.
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Affiliation(s)
| | - Bernard Khor
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - James L. Zehnder
- Department of Pathology; Stanford University School of Medicine; Stanford California
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Dieckmann KP, Anheuser P, Gehrckens R, Aries SP, Ikogho R, Hollburg W. Factor V Leiden mutation triggering four major complications to standard dose cisplatin-chemotherapy for testicular seminoma: a case report. BMC Urol 2015; 15:21. [PMID: 25887618 PMCID: PMC4374368 DOI: 10.1186/s12894-015-0011-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/20/2015] [Indexed: 12/21/2022] Open
Abstract
Background Major life-threatening complications secondary to cisplatin-based chemotherapy are rare in patients with testicular germ cell tumour (GCT). The incidence of complications increases with dosage of chemotherapy and with a variety of patient-related as well as disease-related conditions. We here report the first case of GCT experiencing as many as four major complications most of which can be explained by the conjunction of several predispositions. Case presentation A 48 year old patient with testicular seminoma and bulky retroperitoneal and mediastinal metastases underwent cisplatin based chemotherapy. During the third cycle of chemotherapy, he developed thrombosis of the central venous port device, subtotal splenic infarction, and Bleomycin induced pneumonitis (BIP). Three months after completion of therapy, he was struck by thalamic infarction. Genetic testing then revealed heterozygote mutation of Factor V Leiden (FVL). He received full-dose warfarin anticoagulation treatment and steroid treatment for BIP. 18 months thereafter, the patient is still disease-free, oncologically. Neurological symptoms have disappeared, but pulmonary dysfunction persists with a vital capacity of 50%. Conclusion The unique co-incidence of four major complications occurring in this patient were obviously triggered by the genetically determined predisposition of the patient to thrombotic events (FVL). Additionally, several patient-related and disease-related conditions contributed to the unique pattern of complications, i.e. (1) the slightly advanced age (48 years), (2) the prothrombotic condition caused by the disease of cancer, (3) the central venous port device, (4) retroperitoneal bulky metastasis, and (5) cisplatin chemotherapy. Whether or not FVL contributed to the pulmonary fibrosis as well, remains elusive. Practically, in the case of one major vascular complication during cisplatin chemotherapy at standard dose, genetic testing for hereditary thrombophilia should be considered. Thus, precautions for preventing further complications could be initiated.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Albertinen-Krankenhaus, Department of Urology, Suentelstrasse 11a, D-22457, Hamburg, Germany.
| | - Petra Anheuser
- Albertinen-Krankenhaus, Department of Urology, Suentelstrasse 11a, D-22457, Hamburg, Germany.
| | - Ralf Gehrckens
- Albertinen-Krankenhaus, Department of Diagnostic Radiology, Hamburg, Germany.
| | | | - Raphael Ikogho
- Albertinen-Krankenhaus, Department of Urology, Suentelstrasse 11a, D-22457, Hamburg, Germany.
| | - Wiebke Hollburg
- Hämatologisch-onkologische Praxis Altona (HOPA), Mörkenstrasse 47, D-22767, Hamburg, Germany.
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Pirhoushiaran M, Ghasemi MR, Hami J, Zargari P, Sasan Nezhad P, Azarpazhooh MR, Sadr Nabavi A. The Association of Coagulation Factor V (Leiden) and Factor II (Prothrombin) Mutations With Stroke. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e11548. [PMID: 25763204 PMCID: PMC4329966 DOI: 10.5812/ircmj.11548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 03/24/2014] [Accepted: 08/30/2014] [Indexed: 11/25/2022]
Abstract
Background: Epidemiological studies indicate that over the past forty years, the stroke incidence rates has increased. Factors V and II mutations are established genetic-variant risk factors for venous thrombosis; however, their contribution to stroke is a controversial issue. Objectives: This study aimed to investigate the potential association of FV and FII mutations with stroke in an Iranian population. Patients and Methods: The study population consisted of 153 patients of different stroke subtypes (except cryptogenic strokes), admitted to Ghaem Hospital, Mashhad, Iran. The control group included 153 age- and sex-matched subjects without a history of cerebrovascular or neurologic diseases. Mutations of FV and FII were determined by using a TaqMan SNP Genotyping technique. The chi-square and Exact Fisher tests were used to analyze the baseline characteristics. Results were as follows: The calculated P-value for sex and diabetes mellitus were 0.907 and 1.000, respectively. The case and control groups were also matched in low density lipoprotein (P = 0.816), high density lipoprotein (P = 0.323), triglyceride (P = 0.846), and total cholesterol (P = 0.079). Results: Analysis of the FV showed that none of the study subjects were AA homozygous for this mutation and only 6 heterozygous subjects were detected in the case and control groups. Regarding FII variants, none of the study subjects were AG heterozygous and only 1 AA homozygous was detected in the control group. Conclusions: The prevalence of both FV and FII variants are population based. Iran is an ethnically diverse country. Therefore, for a comprehensive analysis of a potential association of FV and/or FII mutations with stroke among Iranian population, epidemiological studies could be conducted among different ethnic groups.
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Affiliation(s)
- Maryam Pirhoushiaran
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Reza Ghasemi
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Javad Hami
- Department of Anatomical Sciences, School of Medicine, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Peyman Zargari
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, IR Iran
| | - Payam Sasan Nezhad
- Ghaem Medical Center, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahmood Reza Azarpazhooh
- Ghaem Medical Center, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Ariane Sadr Nabavi
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Medical Genetic Research Center (MGRC), School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Iranian Academic Centers for Education, Culture and Research (ACECR), Mashhad, IR Iran
- Corresponding Author: Ariane Sadr Nabavi, Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel/Fax: +98-5118002226, E-mail:
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Kheradmand E, Pourhossein M, Amini G, Saadatnia M. Factor V Leiden does not have a role in cryptogenic ischemic stroke among Iranian young adults. Adv Biomed Res 2014; 3:80. [PMID: 24761388 PMCID: PMC3988598 DOI: 10.4103/2277-9175.127993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 10/27/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Different risk factors have been suggested for ischemic stroke in young adults. In a group of these patients despite of extensive diagnostic work-up, the primary cause remains unknown. Coagulation tendency is accounted as a possible cause in these patients. Previous studies on factor V Leiden (FVL) as the main cause of inherited thrombophilia for clarifying the role of FVL in stroke have resulted in controversial findings. The current study investigates the role of this factor in ischemic stroke among Iranians. MATERIALS AND METHODS This case-control study was performed between September 2007 and December 2008 in Isfahan, Iran. The case group comprised of 22 patients of which 15 were males and 7 were females with age range of ≤50 years, diagnosed as ischemic stroke without classic risk factors and the control group consisted of 54 healthy young adults. After filling consent form, venous blood samples were obtained and sent to the laboratory for genetic examination. RESULTS No FVL mutation was found in the case group. There was one carrier of the mutation as heterozygous in the control group (relative frequency = 1.85%). CONCLUSIONS Based on our study, FVL might not be considered as an independent risk factor for ischemic stroke in Iranian individuals who are not suffering from other risk factors of ischemic stroke.
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Affiliation(s)
- Ehsan Kheradmand
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Meraj Pourhossein
- Department of Genetics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gilda Amini
- Department of Genetics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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Jiang B, Ryan KA, Hamedani A, Cheng Y, Sparks MJ, Koontz D, Bean CJ, Gallagher M, Hooper WC, McArdle PF, O'Connell JR, Stine OC, Wozniak MA, Stern BJ, Mitchell BD, Kittner SJ, Cole JW. Prothrombin G20210A mutation is associated with young-onset stroke: the genetics of early-onset stroke study and meta-analysis. Stroke 2014; 45:961-7. [PMID: 24619398 DOI: 10.1161/strokeaha.113.004063] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Although the prothrombin G20210A mutation has been implicated as a risk factor for venous thrombosis, its role in arterial ischemic stroke is unclear, particularly among young adults. To address this issue, we examined the association between prothrombin G20210A and ischemic stroke in a white case-control population and additionally performed a meta-analysis. METHODS From the population-based Genetics of Early Onset Stroke (GEOS) study, we identified 397 individuals of European ancestry aged 15 to 49 years with first-ever ischemic stroke and 426 matched controls. Logistic regression was used to calculate odds ratios (ORs) in the entire population and for subgroups stratified by sex, age, oral contraceptive use, migraine, and smoking status. A meta-analysis of 17 case-control studies (n=2305 cases <55 years) was also performed with and without GEOS data. RESULTS Within GEOS, the association of the prothrombin G20210A mutation with ischemic stroke did not achieve statistical significance (OR=2.5; 95% confidence interval [CI]=0.9-6.5; P=0.07). However, among adults aged 15 to 42 years (younger than median age), cases were significantly more likely than controls to have the mutation (OR=5.9; 95% CI=1.2-28.1; P=0.03), whereas adults aged 42 to 49 years were not (OR=1.4; 95% CI=0.4-5.1; P=0.94). In our meta-analysis, the mutation was associated with significantly increased stroke risk in adults ≤55 years (OR=1.4; 95% CI=1.1-1.9; P=0.02), with significance increasing with addition of the GEOS results (OR=1.5; 95% CI=1.1-2.0; P=0.005). CONCLUSIONS The prothrombin G20210A mutation is associated with ischemic stroke in young adults and may have an even stronger association among those with earlier onset strokes. Our finding of a stronger association in the younger young adult population requires replication.
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Affiliation(s)
- Baijia Jiang
- From the Departments of Neurology (B.J., A.H., M.J.S., M.A.W., B.J.S., S.J.K., J.W.C.), Medicine (K.A.R., Y.C., P.F.M., J.R.O., B.D.M.), and Epidemiology and Public Health (O.C.S.), University of Maryland School of Medicine, Baltimore; Centers for Disease Control and Prevention, Atlanta, GA (D.K., C.J.B., M.G., W.C.H.); Department of Veterans Affairs, Veterans Affairs Medical Center Baltimore, MD (Y.C., M.A.W., B.J.S., S.J.K., J.W.C.); and Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center, MD (B.D.M., S.J.K.)
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Hamedani AG, Cole JW, Cheng Y, Sparks MJ, O'Connell JR, Stine OC, Wozniak MA, Stern BJ, Mitchell BD, Kittner SJ. Factor V leiden and ischemic stroke risk: the Genetics of Early Onset Stroke (GEOS) study. J Stroke Cerebrovasc Dis 2013; 22:419-23. [PMID: 22100829 PMCID: PMC3288467 DOI: 10.1016/j.jstrokecerebrovasdis.2011.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/14/2011] [Accepted: 10/15/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Factor V Leiden (FVL) has been associated with ischemic stroke in children but not in adults. Although the FVL mutation is associated with increased risk for venous thrombosis, its association with ischemic stroke in young adults remains uncertain. Therefore, we examined the association between FVL and ischemic stroke in participants of the Genetics of Early Onset Stroke (GEOS) study. METHODS A population-based case control study identified 354 women and 476 men 15 to 49 years of age with first-ever ischemic stroke and 907 controls. Participant-specific data included vascular risk factors, FVL genotype and, for cases, the ischemic stroke subtype by modified Trial of ORG 10172 in Acute Stroke criteria. Logistic regression was used to calculate odds ratios for the entire population and for subgroups stratified by risk factors and ischemic stroke subtype. RESULTS The frequency of the FVL mutation was similar between ischemic stroke patients (3.6%; 95% confidence interval [CI] 2.5%-5.1%) and nonstroke controls (3.8%; 95% CI 2.7%-5.2%). This frequency did not change significantly when cases were restricted to patients with stroke of undetermined etiology (4.1%; 95% CI 2.6%-6.4%). CONCLUSIONS Among young adults, we found no evidence for an association between FVL and either all ischemic stroke or the subgroup with stroke of undetermined etiology.
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Affiliation(s)
- Ali G. Hamedani
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - John W. Cole
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Yuching Cheng
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Mary J. Sparks
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey R. O'Connell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Oscar C. Stine
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Marcella A. Wozniak
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Barney J. Stern
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Braxton D. Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Steven J. Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center, Baltimore, MD
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Mulders TA, Maurissen LFA, Meyer Z, Hameeteman M, van der Donk C, Kroon AA, Ferreira I, Stehouwer CDA, Hackeng TM, Pinto-Sietsma SJ. A positive family history for premature cardiovascular disease identifies patients prone to recurrent arterial thrombotic events. Eur J Prev Cardiol 2011; 19:1465-73. [DOI: 10.1177/1741826711422989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ties A Mulders
- University Medical Centre, Maastricht, The Netherlands
- Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Zainna Meyer
- University Medical Centre, Maastricht, The Netherlands
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Muwakkit SA, Majdalani M, Hourani R, Mahfouz RA, Otrock ZK, Bilalian C, Chan AK, Abboud M, Mikati MA. Inherited thrombophilia in childhood arterial stroke: data from Lebanon. Pediatr Neurol 2011; 45:155-8. [PMID: 21824561 DOI: 10.1016/j.pediatrneurol.2011.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 03/21/2011] [Indexed: 12/29/2022]
Abstract
Pediatric ischemic stroke still represents a burden, and more than half of the survivors will experience cognitive or motor disabilities. The objective of this study was to investigate the role of thrombophilia in a cohort of children with arterial ischemic stroke. The records of infants and children with clinically and radiologically confirmed stroke were reviewed. Patients with venous or perinatal stroke were not included. Thirty-three patients were diagnosed with arterial ischemic stroke. The male/female ratio was 1.75:1. The median age was 4 years. The most frequent clinical manifestations were hemiparesis (54.5%) and seizures (33.3%). Genetic thrombophilia testing was available on 24 patients. Nine of the 24 patients (37.5%) were heterozygous for factor V Leiden. None of the patients carried the factor II G20210A variant. Ten patients (41.7%) were heterozygous and 3 (12.5%) were homozygous for methylenetetrahydrofolate reductase (MTHFR) C677T variant. Fifteen patients (62.5%) had one or more genetic polymorphism. Factor V Leiden was significantly associated with arterial ischemic stroke (P < 0.001). Stroke recurred in 2 children with multiple risk factors and MTHFR C677T mutation. Factor V Leiden is one of the major genetic risk factors for pediatric arterial ischemic stroke in Lebanon. MTHFR C677T was prevalent among patients with recurrent stroke.
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Affiliation(s)
- Samar A Muwakkit
- Department of Pediatrics and Adolescent Medicine, Hematology Oncology Service, American University of Beirut Medical Center, Beirut, Lebanon
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Plasminogen activator inhibitor-1 4G/5G promoter polymorphism and PAI-1 plasma levels in young patients with ischemic stroke. Mol Biol Rep 2011; 38:5355-60. [DOI: 10.1007/s11033-011-0687-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 02/25/2011] [Indexed: 10/18/2022]
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15
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Rios DR, Fernandes AP, Carvalho MG, Figueiredo RC, Guimarães DA, Reis DR, Simões e Silva AC, Gomes KB, Dusse LM. Hemodialysis vascular access thrombosis: The role of factor V Leiden, prothrombin gene mutation and ABO blood groups. Clin Chim Acta 2011; 412:425-9. [DOI: 10.1016/j.cca.2010.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/27/2010] [Accepted: 11/01/2010] [Indexed: 12/01/2022]
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16
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Dowaidar M, Settin A. Risk of Myocardial Infarction Related to Factor V Leiden Mutation: A Meta-Analysis. Genet Test Mol Biomarkers 2010; 14:493-8. [DOI: 10.1089/gtmb.2010.0017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Moataz Dowaidar
- Genetics Unit, Egypt and Research Center, College of Medicine, Qassim University, Mansoura University Children Hospital, Buraydah, Saudi Arabia
| | - Ahmad Settin
- Genetics Unit, Egypt and Research Center, College of Medicine, Qassim University, Mansoura University Children Hospital, Buraydah, Saudi Arabia
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Hamedani AG, Cole JW, Mitchell BD, Kittner SJ. Meta-analysis of factor V Leiden and ischemic stroke in young adults: the importance of case ascertainment. Stroke 2010; 41:1599-603. [PMID: 20616326 DOI: 10.1161/strokeaha.110.581256] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The factor V Leiden mutation is associated with ischemic stroke in children but not in adults. Whether it is associated with ischemic stroke in young adults, however, is uncertain. METHODS To address this issue, we performed a meta-analysis of 18 case-control studies of ischemic stroke in adults 50 years of age and younger published before June 2009. RESULTS Across all studies, factor V Leiden was detected in 154 of 2045 cases (7.5%) and 217 of 5307 controls (4.1%), yielding a fixed-effect odds ratio of 2.00 (95% CI, 1.59-2.51). However, further analyses revealed substantial heterogeneity among these studies (P=0.005 for Q-test of heterogeneity). Hypothesizing that this heterogeneity could be related to differences among studies in case selection criteria, we stratified the meta-analysis into studies for which case samples were enriched or not enriched to include cases having an increased likelihood of prothrombotic genetic involvement ("selected" ischemic stroke studies, n=9) and those that recruited cases from consecutive neurology referrals or hospitalizations ("unselected" ischemic stroke studies, n=8). Among the 9 "selected" ischemic stroke studies, factor V Leiden was more strongly associated with stroke (OR, 2.73; 95% CI, 1.98-3.75), whereas among the 8 "unselected" ischemic stroke studies, the association between factor V Leiden and stroke was substantially weaker (OR, 1.40; 95% CI, 0.998-1.95). This difference was found to be statistically significant (P=0.003 for Woolf test for heterogeneity). CONCLUSIONS We conclude that factor V Leiden is associated with ischemic stroke in young adults, particularly in patient populations in which there is an increased clinical suspicion of prothrombotic state.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201-1509, USA
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Stankovic S, Majkic-Singh N. Genetic aspects of ischemic stroke: coagulation, homocysteine, and lipoprotein metabolism as potential risk factors. Crit Rev Clin Lab Sci 2010; 47:72-123. [DOI: 10.3109/10408361003791520] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Shi C, Kang X, Wang Y, Zhou Y. The coagulation factor V Leiden, MTHFRC677T variant and eNOS 4ab polymorphism in young Chinese population with ischemic stroke. Clin Chim Acta 2008; 396:7-9. [PMID: 18602910 DOI: 10.1016/j.cca.2008.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 04/27/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
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21
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Sabino AP, De Oliveira Sousa M, Moreira Lima L, Dias Ribeiro D, Sant'Ana Dusse LM, Das Graças Carvalho M, Fernandes AP. ApoB/ApoA-I ratio in young patients with ischemic cerebral stroke or peripheral arterial disease. Transl Res 2008; 152:113-8. [PMID: 18774540 DOI: 10.1016/j.trsl.2008.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 06/04/2008] [Accepted: 06/25/2008] [Indexed: 11/16/2022]
Abstract
Although smoking and hypertension are classic risk factors for atherothrombotic diseases, the relationship of dyslipidemia and vascular diseases, other than myocardial infarction, is less clearly established, especially in young subjects. In the current study, a detailed analysis of the lipid and apolipoprotein profiles was conducted in young patients of ischemic cerebral stroke (IS) and peripheral arterial disease (PAD). Plasma levels of C-reactive protein (hs-CRP), total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides (TG), and apolipoproteins A-I (ApoA-I) and apolipoproteins B (ApoB), which include the ApoB/ApoA-I ratio, were analyzed in a group of 81 patients who presented with IS (n = 46) or PAD (n = 35) as well as in 167 control subjects. Significant differences were observed for hs-CRP, TC, HDLc, LDLc, TG, ApoA-I, and ApoB levels, as well as for the ApoB/ApoA-I ratio, between the control and the IS or PAD groups. However, after adjustment for sex, age, smoking, hypertension, hs-CRP, and dyslipidemia (LDLc, TC, HDLc, TG, ApoA, ApoB, and ApoB/ApoA-I ratio), hs-CRP, ApoB, and the ApoB/ApoA-I ratio were independently associated with increased risks of IS or PAD. Increased ApoB/ApoA-I ratio and hs-CRP levels are independently associated with occurrence of IS and PAD in young patients and are significant markers of alterations on lipid and apolipoproteic profiles and inflammatory responses, respectively, in these patients.
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Affiliation(s)
- Adriano Paula Sabino
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil, University Hospital-Federal University of Minas Gerais Belo Horizonte, MG, Brazil
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Bersano A, Ballabio E, Bresolin N, Candelise L. Genetic polymorphisms for the study of multifactorial stroke. Hum Mutat 2008; 29:776-95. [PMID: 18421701 DOI: 10.1002/humu.20666] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Single-gene disorders explain only a minority of stroke cases. Stroke represents a complex trait, which is usually assumed to be polygenic. On this topic, the role of a wide number of candidate genes has been investigated in stroke through association studies, with controversial results. Therefore, it is difficult for the clinician to establish the validity and the level of clinical applicability of the previously reported associations between genetic factors and stroke. This review is an update and an extensive analysis of the more recent association studies conducted in stroke. We evaluated a number of studies on several candidate genes (including F5, F2, FGA/FGB/FGG, F7, F13A1, vWF, F12, SERPINE1, ITGB3/PLA1/PLA2/ITGA2B, ITGA2, GP1BA, ACE, AGT, NOS3, APOE, LPL, PON1, PDE4D, ALOX5AP, MTHFR, MTR, and CBS), providing a final panel of genes and molecular variants. We categorized this panel in relation to the degree of association with stroke, supported by the results of meta-analyses and case-control studies. Our findings could represent a useful tool to address further molecular investigations and to realize more detailed meta-analyses.
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Affiliation(s)
- A Bersano
- Dipartimento di Scienze Neurologiche, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Università degli Studi di Milano, Milano, Italy
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Settin A, Dowaidar M, El-Baz R, Abd-Al-Samad A, El-Sayed I, Nasr M. Frequency of factor V Leiden mutation in Egyptian cases with myocardial infarction. Hematology 2008; 13:170-174. [DOI: 10.1179/102453308x316158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Ahmad Settin
- Genetic UnitGenetic Engineering & Biotechnology Research Institute, Menoufya University, Egypt
| | - Moataz Dowaidar
- Molecular Biology DepartmentGenetic Engineering & Biotechnology Research Institute, Menoufya University, Egypt
| | - Rizk El-Baz
- Genetic UnitGenetic Engineering & Biotechnology Research Institute, Menoufya University, Egypt
| | - Ayman Abd-Al-Samad
- Cardiology DepartmentInternal Medicine University Hospital, Mansoura, Egypt
| | - Ibrahim El-Sayed
- Cardiology DepartmentInternal Medicine University Hospital, Mansoura, Egypt
| | - Mahmoud Nasr
- Molecular Biology DepartmentGenetic Engineering & Biotechnology Research Institute, Menoufya University, Egypt
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Polymorphism in the methylenetetrahydrofolate reductase (C677T) gene and homocysteine levels: a comparison in Brazilian patients with coronary arterial disease, ischemic stroke and peripheral arterial obstructive disease. J Thromb Thrombolysis 2007; 27:82-7. [DOI: 10.1007/s11239-007-0172-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 11/12/2007] [Indexed: 10/22/2022]
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Dusse LMS, Carvalho MDG, Bragança WF, Paiva SG, Godoi LC, Guimarães DAM, Fernandes AP. Inherited thrombophilias and pre-eclampsia in Brazilian women. Eur J Obstet Gynecol Reprod Biol 2007; 134:20-3. [PMID: 17097210 DOI: 10.1016/j.ejogrb.2006.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 08/29/2006] [Accepted: 09/15/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the present study was to compare the distribution of G1691A, G20210A and C677T mutations in pre-eclamptic Brazilian women and in matched control women with an uncomplicated normal pregnancy. STUDY DESIGN these mutations were investigated by PCR-RFLP in 83 normal pregnancies (control group) and in 30 pre-eclamptic pregnant women (severe form). RESULTS G1691A mutation was detected neither in the control group nor in pre-eclamsia women. G20210A mutation was detected in heterozygosis in 3 (3.61%) control subjects, but not in pre-eclampsia group. C677T mutation was detected in homozygosis in 6 (7.23%) control subjects and 2 (6.67%) pre-eclamptic women and in heterozygosis in 31 (37.3%) control subjects and 12 (40%) pre-eclamptic women. Differences in the mutation frequencies detected in the two groups were not statistically significant. CONCLUSION No correlation was observed between pre-eclampsia and presence of G1691A, G20210A and C677T mutations in Brazilian women.
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Affiliation(s)
- Luci Maria Santana Dusse
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Glueck CJ, Munjal J, Aregawi D, Agloria M, Winiarska M, Khalil Q, Wang P. Thrombophilia-hypofibrinolysis and atherothrombotic cardiovascular disease < or = age 45 years. Transl Res 2007; 150:93-100. [PMID: 17656328 DOI: 10.1016/j.trsl.2007.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 03/07/2007] [Accepted: 03/10/2007] [Indexed: 11/28/2022]
Abstract
Thrombophilia-hypofibrinolysis may play an important role in rare premature (< or = age 45 years) arterial occlusive events in atherothrombotic cardiovascular (ATCVD) disease, particularly in normolipidemic patients. Whether thrombophilia-hypofibrinolysis contributed to ATCVD < or = age 45 years was assessed in 78 men and 40 women with 230 ATCVD events (myocardial infarction (MI) [n = 60], coronary artery bypass graft [CABG, n = 33], angioplasty [n = 52], chronic angina [n = 41], ischemic stroke [n = 11], transient ischemic attack [TIA, n = 24], claudication [n = 9]). Cases were compared with healthy normal adult controls (44 men and 76 women). In men, the Factor V Leiden mutation was present in 6/63 (10%) cases versus 0/44 (0%) controls (P = 0.042), Factor VIII was high (>150%) in 16/60 (27%) cases versus 1/42 (2%) controls (P = 0.001), Factor XI was high (>150%) in 9/57 (16%) cases versus 0/42 (0%) controls (P = 0.009), and plasminogen activator inhibitor activity (PAI-Fx) was high (>21.1 U/mL) in 15/63 (24%) cases versus 3/43 (7%) controls (P = 0.023). In women, protein C was low (<73%) in 4/26 (15%) cases versus 0/74 (0%) controls (P = 0.004), and free protein S was low (<66%) in 5/27 (19%) cases versus 2/74 (3%) controls (P = 0.014). In women, Factor XI was high (>150%) in 3/27 (11%) cases versus 1/74 (1%) controls (P = 0.057), and the lupus anticoagulant was present in 9/32 (28%) cases versus 2/51 (4%) controls (P = 0.002). In patients with ATCVD < or = age 45 years, thrombophilias (Factor V Leiden, Factor VIII, Factor XI, protein C and S deficiency, lupus anticoagulant) and hypofibrinolysis (PAI-Fx, Lp[a]) may promote arterial thrombosis, which is synergistic with atherosclerotic endothelial injury.
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de Paula Sabino A, Guimarães DAM, Ribeiro DD, Paiva SG, Sant'Ana Dusse LM, das Graças Carvalho M, Fernandes AP. Increased Factor V Leiden frequency is associated with venous thrombotic events among young Brazilian patients. J Thromb Thrombolysis 2007; 24:261-6. [PMID: 17401546 DOI: 10.1007/s11239-007-0024-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 02/27/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Of the inherited thrombophilias, the Factor V Leiden (FVL) and the prothrombin mutant (FII G20210A) are associated with increased risk of venous thromboembolism (VTE). The C677T mutation of the methylenetetrahydrofolate reductase gene, which may lead to hyperhomocysteinemia, is also considered a risk factor for VTE in some studies. However, the frequency of these genetic risk factors may vary significantly among different populations. MATERIAL AND METHODS The FVL, FII G20210A and C677T mutations were investigated by PCR-RFLP in 275 young VTE Brazilian patients as well as in 324 biologically unrelated individuals selected to compose the control group. RESULTS The C677T mutation in the MTHFR gene was detected in 135 (49.1%) patients, of which 117 (42.5%) were identified as heterozygous and 18 (6.5%) as homozygous. The G20210A mutation was detected in 14 (5.1%) patients in heterozygosis. In both cases, no significant difference was observed when these results were compared to the frequencies observed in the control group. FVL was detected in heterozygosis in 19 (6.9%) patients, corresponding to a significantly increased frequency when compared to that observed for the control group (1.2%) (OR 5.9; 95% CI 2.08-16.79; p < 0.001). CONCLUSIONS The data indicated that FVL is significantly associated with VTE among young Brazilian patients, but also supported previous evidence that VTE is a multi-factorial disease, resulting from the interaction of genetic and acquired risk factors.
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Affiliation(s)
- Adriano de Paula Sabino
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, 31270-901 Belo Horizonte, MG, Brazil
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