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Thromb Haemost 2015; 113(03): 641-648
DOI: 10.1160/TH14-06-0566
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH

Determinants of premature familial arterial thrombosis in patients with juvenile ischaemic stroke

The Italian Project on Stroke in Young Adults (IPSYS)
Alessandro Pezzini
1   Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
,
Mario Grassi
2   Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italy
,
Corrado Lodigiani
3   Centro Trombosi, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy
,
Rosalba Patella
4   Stroke Unit, Azienda Ospedaliera Sant’Andrea, Roma, Italy
,
Carlo Gandolfo
5   Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italy
,
Andrea Zini
6   Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile “S. Agostino Estense”, AUSL Modena, Italy
,
Maria Luisa DeLodovici
7   Unità di Neurologia, Ospedale di Circolo, Università dell’Insubria, Varese, Italy
,
Maurizio Paciaroni
8   Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italy
,
Massimo Del Sette
9   Unità di Neurologia, Ospedale S. Andrea, La Spezia, Italy
,
Antonella Toriello
10   U.O.C. Neurologia, A.O Universitaria “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
,
Rossella Musolino
11   Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, Messina, Italy
,
Rocco Salvatore Calabrò
12   Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Messina, Italy
,
Paolo Bovil
13   UO Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, Verona, Italy
,
Alessandro Adami
14   Stroke Center, Dipartimento di Neurologia, Ospedale Sacro Cuore Negrar, Verona, Italy
,
Giorgio Silvestrelli
15   Stroke Unit, U.O Neurologia, Azienda Ospedaliera “C. Poma”, Mantova, Italy
,
Maria Sessa
16   Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italy
,
Anna Cavallini
17   U.C Malattie Cerebrovascolari e Stroke Unit (A.C.), IRCCS Fondazione Istituto Neurologico Nazionale “C. Mondino”, Pavia, Italy
,
Simona Marcheselli
18   Neurologia d’Urgenza and Stroke Unit, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy
,
Domenico Marco Bonifati
19   Stroke Unit, U.O Neurologia, Ospedale “S. Chiara”, Trento, Italy
,
Nicoletta Checcarelli
20   U.O.C Neurologia, Ospedale Valduce, Como, Italy
,
Lucia Tancredi
21   U.O Neurologia, Azienda Ospedaliera Ospedale Sant’Anna, Como, Italy
,
Alberto Chiti
22   Neurologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
,
Elisabetta Del Zotto
23   U.O Recupero e Rieducazione Funzionale, IRCCS Fondazione Don Gnocchi, Milano, Italy
,
Alessandra Spalloni
4   Stroke Unit, Azienda Ospedaliera Sant’Andrea, Roma, Italy
,
Paolo Costa
1   Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
,
Giacomo Giacalone
16   Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italy
,
Paola Ferrazzi
3   Centro Trombosi, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy
,
Loris Poli
1   Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
,
Morotti Andrea
1   Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
,
Rasura Maurizia
4   Stroke Unit, Azienda Ospedaliera Sant’Andrea, Roma, Italy
,
Anna Maria Simone
6   Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile “S. Agostino Estense”, AUSL Modena, Italy
,
Massimo Gamba
24   Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy
,
Paolo Cerrato
25   Dipartimento di Neuroscienze, Stroke Unit, Università di Torino, Torino, Italy
,
Giuseppe Micieli
26   U.C Neurologia d’Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale “C. Mondino,” Pavia, Italy
,
Maurizio Melis
27   Stroke Unit, Azienda Ospedaliera “G. Brotzu”, Cagliari, Italy
,
Davide Massucco
5   Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italy
,
Valeria De Giuli
1   Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
,
Daniele Pepe
2   Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italy
,
Licia Iacoviello
28   Laboratorio di Epidemiologia Molecolare e Nutrizionale, Dipartimento di Epidemiologia e Prevenzione, IRCCS Istituto Neurologico Mediterraneo, NEUROMED, Pozzilli, Italy
,
Alessandro Padovani
1   Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
› Author Affiliations Financial support: The Italian Project on Stroke in Young Adults (IPSYS) is supported by a grant from the Associazione per la Lotta alla Trombosi e alle Malattie Cardiovascolari (ALT). The sponsor had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication.
Further Information

Publication History

Received: 30 June 2014

Accepted after major revision: 28 September 2014

Publication Date:
29 November 2017 (online)

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Summary

Factors predicting family history (FH) of premature arterial thrombosis in young patients with ischaemic stroke (IS) have not been extensively investigated, and whether they might influence the risk of post-stroke recurrence is still unknown. In the present study we analysed 1,881 consecutive first-ever IS patients aged 18–45 years recruited from January 2000 to January 2012 as part of the Italian Project on Stroke in Young Adults (IPSYS). FH of premature arterial thrombosis was any thrombotic event [IS, myocardial infarction or other arterial events event] > 45 years in proband’s first-degree relatives. Compared with patients without FH of premature arterial thrombosis, those with FH (n= 85) were more often smokers (odds ratio [OR], 1.94; 95 % confidence interval [CI], 1.21–3.09) and carriers of procoagulant abnormalities (OR, 3.66; 95 % CI, 2.21–6.06). Smoking (OR, 2.48; 95 % CI, 1.20–5.15), the A1691 mutation in factor V gene (OR, 3.64; 95 % CI, 1.31–10.10), and the A20210 mutation in the prothrombin gene (OR, 8.40; 95 % CI 3.35–21.05) were associated with FH of premature stroke (n = 33), while circulating anti-phospholipids to FH of premature myocardial infarction (n = 45; OR, 3.48; 95 % CI, 1.61–7.51). Mean follow-up time was 46.6 ± 38.6 months. Recurrent events occurred more frequently in the subgroup of patients with FH of premature stroke [19.4 %); p = 0.051] compared to patients without such a FH. In conclusion, young IS patients with FH of premature arterial thrombosis exhibit a distinct risk-factor profile, an underlying procoagulant state and have worse vascular prognosis than those with no FH of juvenile thrombotic events.

Keywords

Stroke in young adults - cohort studies - risk factors in epidemiology
 

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