Abstract
Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. A retrospective study was conducted from 85 consecutive young patients treated as outpatients or admitted due to stroke or myocardial infarction at a tertiary care hospital. Eighty-five Indian patients (age < 45 years) presenting ischemic stroke (n = 48) or myocardial infarction (n = 37) and 50 controls were studied for seven thrombophilia markers including antithrombin (AT), factor V, protein C, protein S, activated protein C resistance (APC-R), fibrinogen and Lp(a). Functional assays for protein C, protein S, factor V and APC-R were performed using clotting-based methods. Semi-quantitative estimation of fibrinogen was done using Clauss's method and Lp(a) using immunoturbidimetry. Statistical analysis was done using the Epi Info 6 software. Thirty-three samples (38.8%) tested positive for one or more thrombophilia markers. The three commonest abnormalities were elevated Lp(a) (20%), fibrinogen (17.6%) and low APC-R (14.2%). Low levels of protein C, protein S and AT were present in 4.7, 9.4 and 7% of the patients, respectively. Overall, the risk factor profile was: smoking (33%), positive family history (15.3%), hyperlipidemia (7%), hypertension, diabetes mellitus and obesity (2.3% each). An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance.
Highlights
Inherited thrombophilia is more commonly associated with venous rather than arterial thrombosis
There is controversy regarding the role of inherited causes of thrombophilia such as deficiencies of natural anticoagulants and activated protein C resistance (APC-R) in arterial thrombosis, while increased fibrinogen levels and acquired causes such as antiphospholipid antibodies have been implicated
Multiple episodes of thrombosis occurred in 11 patients, of whom seven had myocardial infarction (MI), three had stroke and one had both
Summary
Inherited thrombophilia is more commonly associated with venous rather than arterial thrombosis. There is controversy regarding the role of inherited causes of thrombophilia such as deficiencies of natural anticoagulants (antithrombin, protein C and protein S) and activated protein C resistance (APC-R) in arterial thrombosis, while increased fibrinogen levels and acquired causes such as antiphospholipid antibodies have been implicated. Especially protein C deficiency, are more common in children with a first arterial ischemic stroke than in healthy children.[1] The likelihood of detecting at least one thrombophilia marker in young patients with myocardial infarction (MI) who have fewer conventional risk factors is significantly high.[2]
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Schedule a callMore From: Sao Paulo medical journal = Revista paulista de medicina
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