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

Alessandro Pezzini; Mario Grassi; Corrado Lodigiani; Rosalba Patella; Carlo Gandolfo; Andrea Zini; Maria Luisa DeLodovici; Maurizio Paciaroni; Massimo Del Sette; Antonella Toriello; Rossella Musolino; Rocco Salvatore Calabrò; Paolo Bovil; Alessandro Adami; Giorgio Silvestrelli; Maria Sessa; Anna Cavallini; Simona Marcheselli; Domenico Marco Bonifati; Nicoletta Checcarelli; Lucia Tancredi; Alberto Chiti; Elisabetta Del Zotto; Alessandra Spalloni; Paolo Costa; Giacomo Giacalone; Paola Ferrazzi; Loris Poli; Morotti Andrea; Rasura Maurizia; Anna Maria Simone; Massimo Gamba; Paolo Cerrato; Giuseppe Micieli; Maurizio Melis; Davide Massucco; Valeria De Giuli; Daniele Pepe; Licia Iacoviello; Alessandro Padovani

doi:10.1160/TH14-06-0566

Thrombosis and Haemostasis, Inhaltsverzeichnis

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

¹Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy

,

Mario Grassi

²Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italy

,

Corrado Lodigiani

³Centro Trombosi, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy

,

Rosalba Patella

⁴Stroke Unit, Azienda Ospedaliera Sant’Andrea, Roma, Italy

,

Carlo Gandolfo

⁵Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italy

,

Andrea Zini

⁶Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile “S. Agostino Estense”, AUSL Modena, Italy

,

Maria Luisa DeLodovici

⁷Unità di Neurologia, Ospedale di Circolo, Università dell’Insubria, Varese, Italy

,

Maurizio Paciaroni

⁸Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italy

,

Massimo Del Sette

⁹Unità di Neurologia, Ospedale S. Andrea, La Spezia, Italy

,

Antonella Toriello

¹⁰U.O.C. Neurologia, A.O Universitaria “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy

,

Rossella Musolino

¹¹Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, Messina, Italy

,

Rocco Salvatore Calabrò

¹²Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Messina, Italy

,

Paolo Bovil

¹³UO Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, Verona, Italy

,

Alessandro Adami

¹⁴Stroke Center, Dipartimento di Neurologia, Ospedale Sacro Cuore Negrar, Verona, Italy

,

Giorgio Silvestrelli

¹⁵Stroke Unit, U.O Neurologia, Azienda Ospedaliera “C. Poma”, Mantova, Italy

,

Maria Sessa

¹⁶Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italy

,

Anna Cavallini

¹⁷U.C Malattie Cerebrovascolari e Stroke Unit (A.C.), IRCCS Fondazione Istituto Neurologico Nazionale “C. Mondino”, Pavia, Italy

,

Simona Marcheselli

¹⁸Neurologia d’Urgenza and Stroke Unit, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy

,

Domenico Marco Bonifati

¹⁹Stroke Unit, U.O Neurologia, Ospedale “S. Chiara”, Trento, Italy

,

Nicoletta Checcarelli

²⁰U.O.C Neurologia, Ospedale Valduce, Como, Italy

,

Lucia Tancredi

²¹U.O Neurologia, Azienda Ospedaliera Ospedale Sant’Anna, Como, Italy

,

Alberto Chiti

²²Neurologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

,

Elisabetta Del Zotto

²³U.O Recupero e Rieducazione Funzionale, IRCCS Fondazione Don Gnocchi, Milano, Italy

,

Alessandra Spalloni

⁴Stroke Unit, Azienda Ospedaliera Sant’Andrea, Roma, Italy

,

Paolo Costa

¹Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy

,

Giacomo Giacalone

¹⁶Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italy

,

Paola Ferrazzi

³Centro Trombosi, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy

,

Loris Poli

¹Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy

,

Morotti Andrea

¹Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy

,

Rasura Maurizia

⁴Stroke Unit, Azienda Ospedaliera Sant’Andrea, Roma, Italy

,

Anna Maria Simone

⁶Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile “S. Agostino Estense”, AUSL Modena, Italy

,

Massimo Gamba

²⁴Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy

,

Paolo Cerrato

²⁵Dipartimento di Neuroscienze, Stroke Unit, Università di Torino, Torino, Italy

,

Giuseppe Micieli

²⁶U.C Neurologia d’Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale “C. Mondino,” Pavia, Italy

,

Maurizio Melis

²⁷Stroke Unit, Azienda Ospedaliera “G. Brotzu”, Cagliari, Italy

,

Davide Massucco

⁵Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italy

,

Valeria De Giuli

¹Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy

,

Daniele Pepe

²Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italy

,

Licia Iacoviello

²⁸Laboratorio di Epidemiologia Molecolare e Nutrizionale, Dipartimento di Epidemiologia e Prevenzione, IRCCS Istituto Neurologico Mediterraneo, NEUROMED, Pozzilli, Italy

,

Alessandro Padovani

¹Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy

› Institutsangaben

Abstract

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

Volltext

Referenzen

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