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

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    Authors
    Morris, Jane G.
    Singh, Swaraj
    Fisher, Marc
    UMass Chan Affiliations
    Department of Neurology
    Document Type
    Journal Article
    Publication Date
    2010-12-16
    Keywords
    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
    Neurology
    Neuroscience and Neurobiology
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    Link to Full Text
    http://dx.doi.org/10.1161/STROKEAHA.110.595199
    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.
    Source
    Stroke. 2010 Dec;41(12):2985-90. Epub 2010 Oct 14. Link to article on publisher's site
    DOI
    10.1161/STROKEAHA.110.595199
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37720
    PubMed ID
    20947844
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1161/STROKEAHA.110.595199
    Scopus Count
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    UMass Chan Faculty and Researcher Publications

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