Title

Testing for inherited thrombophilias in arterial stroke: can it cause more harm than good

UMMS Affiliation

Department of Neurology

Date

12-16-2010

Document Type

Article

Subjects

Antithrombin III Deficiency; Brain Ischemia; Case-Control Studies; Cost-Benefit Analysis; Factor V Deficiency; Foramen Ovale, Patent; Humans; Protein C Deficiency; Protein S Deficiency; Stroke; Thrombophilia

Disciplines

Neurology | Neuroscience and Neurobiology

Abstract

BACKGROUND AND PURPOSE: Despite a paucity of evidence supporting a true association of ischemic stroke and the inherited thrombophilias, it is common practice for many neurologists to order these tests as part of the work-up of ischemic stroke, especially in young patients. Treatment with oral anticoagulation is often used in patients with positive results for the inherited thrombophilias.

METHODS: We reviewed the literature focusing on case-control studies of the 5 most commonly inherited disorders of coagulation: protein C deficiency, protein S deficiency, antithrombin deficiency, and the factor V Leiden and prothrombin gene mutations in patients with stroke. We also analyzed the available data on stroke patients with inherited thrombophilia and patent foramen ovale.

RESULTS: Multiple case-control studies have not convincingly shown an association of the inherited thrombophilias with ischemic stroke, even in young patients and patients with patent foramen ovale.

CONCLUSIONS: If there is an association between the inherited thrombophilias and arterial stroke, then it is a weak one, likely enhanced by other prothrombotic risk factors. The consequences of ordering these tests and attributing causality to an arterial event can result in significant costs to the health care system and pose a potential risk to patients, because this may lead to inappropriate use of long-term oral anticoagulants, exposing patients to harm without a clearly defined benefit.

Rights and Permissions

Citation: Stroke. 2010 Dec;41(12):2985-90. Epub 2010 Oct 14. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

20947844