For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
Inviting an author to review:
The effect of COPD severity and study duration on exacerbation outcome in randomized controlled trials
Find an author and click ‘Invite to review selected article’ near their name.
Search for authorsSearch for similar articles
4
views
55
references
 Top references
cited by
25
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      695
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Inherited Thrombophilia and the Risk of Arterial Ischemic Stroke: A Systematic Review and Meta‐Analysis

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Inherited thrombophilias are well‐established predisposing factors for venous thromboembolism, but their role in arterial thrombosis, such as arterial ischemic stroke, remains uncertain. We aimed to evaluate the association between inherited thrombophilia (factor V Leiden, prothrombin G20210A mutation, protein C deficiency, protein S deficiency, and antithrombin deficiency) and risk of arterial ischemic stroke in adults.

          Methods and Results

          We searched PubMed, EMBASE, and Cochrane Library Databases from inception to December 31, 2018. We included case‐control or cohort studies of adults reporting the prevalence of inherited thrombophilias in those with arterial ischemic stroke and subjects without arterial ischemic stroke. Two reviewers (T.C., E.D.) independently searched the literature and extracted data. Pooled odds ratios ( ORs) and 95% CIs were calculated using random‐effects model. We identified 68 eligible studies, which collectively enrolled 11 916 stroke patients and 96 057 controls. The number of studies reporting factor V Leiden, prothrombin G20210A mutation, protein C deficiency, protein S deficiency, and antithrombin deficiency were 56, 45, 15, 17, and 12, respectively. Compared with controls, patients with arterial ischemic stroke were significantly more likely to have the following inherited thrombophilias: factor V Leiden ( OR, 1.25; 95% CI, 1.08–1.44; I 2=0%), prothrombin G20210A mutation ( OR, 1.48; 95% CI, 1.22–1.80; I 2=0%), protein C deficiency ( OR, 2.13; 95% CI, 1.16–3.90; I 2=0%), and protein S deficiency ( OR, 2.26; 95% CI, 1.34–3.80; I 2=8.8%). Statistical significance was not reached for antithrombin deficiency ( OR, 1.25; 95% CI, 0.58–2.67; I 2=8.8%).

          Conclusions

          Inherited thrombophilias (factor V Leiden, prothrombin G20210A mutation, protein C deficiency, and protein S deficiency) are associated with an increased risk of arterial ischemic stroke in adults. The implications of these findings with respect to clinical management of patients with ischemic stroke require further investigation.

          Related collections

          Most cited references55

          • Record: found
          • Abstract: found
          • Article: not found

          A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke.

          David C. Jackson, L Pettigrew, Jason Lazar … (2001)
          Despite the use of antiplatelet agents, usually aspirin, in patients who have had an ischemic stroke, there is still a substantial rate of recurrence. Therefore, we investigated whether warfarin, which is effective and superior to aspirin in the prevention of cardiogenic embolism, would also prove superior in the prevention of recurrent ischemic stroke in patients with a prior noncardioembolic ischemic stroke. In a multicenter, double-blind, randomized trial, we compared the effect of warfarin (at a dose adjusted to produce an international normalized ratio of 1.4 to 2.8) and that of aspirin (325 mg per day) on the combined primary end point of recurrent ischemic stroke or death from any cause within two years. The two randomized study groups were similar with respect to base-line risk factors. In the intention-to-treat analysis, no significant differences were found between the treatment groups in any of the outcomes measured. The primary end point of death or recurrent ischemic stroke was reached by 196 of 1103 patients assigned to warfarin (17.8 percent) and 176 of 1103 assigned to aspirin (16.0 percent; P=0.25; hazard ratio comparing warfarin with aspirin, 1.13; 95 percent confidence interval, 0.92 to 1.38). The rates of major hemorrhage were low (2.22 per 100 patient-years in the warfarin group and 1.49 per 100 patient-years in the aspirin group). Also, there were no significant treatment-related differences in the frequency of or time to the primary end point or major hemorrhage according to the cause of the initial stroke (1237 patients had had previous small-vessel or lacunar infarcts, 576 had had cryptogenic infarcts, and 259 had had infarcts designated as due to severe stenosis or occlusion of a large artery). Over two years, we found no difference between aspirin and warfarin in the prevention of recurrent ischemic stroke or death or in the rate of major hemorrhage. Consequently, we regard both warfarin and aspirin as reasonable therapeutic alternatives.
          Article 0 comments Cited 134 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Loci associated with ischaemic stroke and its subtypes (SiGN): a genome-wide association study

            (2016)
            The discovery of disease-associated loci through genome-wide association studies (GWAS) is the leading genetic approach to the identification of novel biological pathways underlying diseases in humans. Until recently, GWAS in ischaemic stroke have been limited by small sample sizes and have yielded few loci associated with ischaemic stroke. We did a large-scale GWAS to identify additional susceptibility genes for stroke and its subtypes.
            Article 0 comments Cited 81 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies.

              Kevin Rostásy, Janna Journeycake, J. Lynch … (2010)
              The aim of this study was to estimate the impact of thrombophilia on risk of first childhood stroke through a meta-analysis of published observational studies. A systematic search of electronic databases (Medline via PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2009 was conducted. Data on year of publication, study design, country of origin, number of patients/control subjects, ethnicity, stroke type (arterial ischemic stroke [AIS], cerebral venous sinus thrombosis [CSVT]) were abstracted. Publication bias indicator and heterogeneity across studies were evaluated, and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with fixed-effects or random-effects models. Twenty-two of 185 references met inclusion criteria. Thus, 1764 patients (arterial ischemic stroke [AIS], 1526; cerebral sinus venous thrombosis [CSVT], 238) and 2799 control subjects (neonate to 18 years of age) were enrolled. No significant heterogeneity was discerned across studies, and no publication bias was detected. A statistically significant association with first stroke was demonstrated for each thrombophilia trait evaluated, with no difference found between AIS and CSVT. Summary ORs (fixed-effects model) were as follows: antithrombin deficiency, 7.06 (95% CI, 2.44 to 22.42); protein C deficiency, 8.76 (95% CI, 4.53 to 16.96); protein S deficiency, 3.20 (95% CI, 1.22 to 8.40), factor V G1691A, 3.26 (95% CI, 2.59 to 4.10); factor II G20210A, 2.43 (95% CI, 1.67 to 3.51); MTHFR C677T (AIS), 1.58 (95% CI, 1.20 to 2.08); antiphospholipid antibodies (AIS), 6.95 (95% CI, 3.67 to 13.14); elevated lipoprotein(a), 6.27 (95% CI, 4.52 to 8.69), and combined thrombophilias, 11.86 (95% CI, 5.93 to 23.73). In the 6 exclusively perinatal AIS studies, summary ORs were as follows: factor V, 3.56 (95% CI, 2.29 to 5.53); and factor II, 2.02 (95% CI, 1.02 to 3.99). The present meta-analysis indicates that thrombophilias serve as risk factors for incident stroke. However, the impact of thrombophilias on outcome and recurrence risk needs to be further investigated.
              Article 0 comments Cited 65 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Contributors
                Thita Chiasakul: thita.c@chula.ac.th
                Journal
                Journal ID (nlm-ta): J Am Heart Assoc
                Journal ID (iso-abbrev): J Am Heart Assoc
                Journal ID (doi): 10.1002/(ISSN)2047-9980
                Journal ID (publisher-id): JAH3
                Journal ID (hwp): ahaoa
                Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2047-9980
                Publication date (Electronic): 24 September 2019
                Publication date Collection: 01 October 2019
                Volume: 8
                Issue: 19 ( doiID: 10.1002/jah3.v8.19 )
                Electronic Location Identifier: e012877
                Affiliations
                [ 1 ] Division of Hematology Department of Medicine Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand
                [ 2 ] Tufts University School of Medicine Boston MA
                [ 3 ] Department of Biostatistics and Epidemiology Perelman School of Medicine University of Pennsylvania Philadelphia PA
                [ 4 ] Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia PA
                [ 5 ] Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
                [ 6 ] Department of Pathology and Laboratory Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
                [ 7 ] Department of Medicine McMaster University Hamilton Ontario Canada
                [ 8 ] Department of Medicine University of Washington School of Medicine Seattle WA
                [ 9 ] Faculty of Medicine Chiang Mai University Chiang Mai Thailand
                Author notes
                [*] [* ] Correspondence to: Thita Chiasakul, MD, MSc, King Chulalongkorn Memorial Hospital, Rama IV Road, Pathumwan, Bangkok, Thailand 10330. E‐mail: thita.c@ 123456chula.ac.th
                Article
                Publisher ID: JAH34477
                DOI: 10.1161/JAHA.119.012877
                PMC ID: 6806047
                PubMed ID: 31549567
                SO-VID: 175e40f5-a476-4534-89d0-64ab40214352
                Copyright © © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date received : 03 April 2019
                Date accepted : 04 September 2019
                Page count
                Figures: 3, Tables: 2, Pages: 12, Words: 8311
                Categories
                Subject: Systematic Review and Meta‐analysis
                Subject: Systematic Review and Meta‐analysis
                Custom metadata
                source-schema-version-number 2.0
                component-id jah34477
                cover-date 1 October 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.9 mode:remove_FC converted:01.10.2019

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: hypercoagulopathy,stroke,stroke, ischemic,thrombosis,cerebrovascular disease/stroke,ischemic stroke
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: hypercoagulopathy, stroke, stroke, ischemic, thrombosis, cerebrovascular disease/stroke, ischemic stroke

                Comments

                Comment on this article

                scite_

                Similar content695

                See all similar

                Cited by25

                See all cited by

                Most referenced authors1,983

                See all reference authors