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Is testing for inherited coagulation inhibitor deficiencies in young stroke patients worthwhile?
M Amiri1, J W Schmidley, L M Fink
1Department of Neurology, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Mail Stop 500, 4301 West Markham, 72205, Little Rock, AR, USA.
Insights
Testing for inherited coagulation inhibitor deficiencies like protein C, protein S, and antithrombin III is unlikely to be beneficial in young stroke patients without a clear family or medical history suggesting such disorders.
Area of Science:
- Neurology
- Hematology
- Genetics
Background:
- Cerebral infarcts in young adults can have various causes.
- Inherited thrombophilias are potential risk factors for arterial ischemic stroke.
- Screening for coagulation inhibitor deficiencies is considered in specific patient populations.
Purpose of the Study:
- To evaluate the diagnostic yield of laboratory testing for inherited deficiencies of protein C, protein S, and antithrombin III.
- To assess the hypothesis that such testing is low in young patients (<50 years) with first arterial ischemic cerebral infarcts and no suggestive family or medical history.
Main Methods:
- A cohort of 55 patients under age 50 with a first arterial ischemic cerebral infarct was studied.
- Systematic laboratory investigation for deficiencies in protein C, protein S, and antithrombin III was performed.
Main Results:
- No deficiencies in protein C or antithrombin III were identified in the study cohort.
- One patient exhibited a deficiency in protein S, deemed likely acquired rather than inherited.
Conclusions:
- The laboratory search for inherited deficiencies of protein C, protein S, and antithrombin III yields limited results in young stroke patients lacking clinical indicators of a prothrombotic state.
- Routine screening for these specific inherited coagulation disorders may not be cost-effective in this patient group.
Objective:
To test the hypothesis that in patients under age 50, with a first, arterial, ischemic cerebral infarct, whose family history and medical history do not suggest an inherited coagulation inhibitor deficiency, the yield of a laboratory search for these disorders will be low.
Materials And Methods:
In 55 such patients under age 50, we systematically searched for deficiencies of protein C, protein S, and antithrombin III.
Results:
No abnormalities of protein C or antithrombin III were found. One patient had a deficiency of protein S, which was most likely acquired rather than inherited.
Conclusions:
In patients who lack clinical features of a prothrombotic state, the yield of testing for protein C, S and AT III deficiency is likely to be low.
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