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Protein S deficiency in middle-aged women with stroke
1Department of Medicine, Northwestern University Medical School, Chicago, IL.
Insights
Protein S deficiency may increase stroke risk in middle-aged women. Lower free protein S levels were observed in women with thrombotic strokes compared to men.
Area of Science:
- Hematology
- Neurology
- Vascular Medicine
Background:
- Cerebrovascular disease encompasses conditions like cerebral thrombosis and embolism.
- Coagulation disorders, including protein S deficiency, are potential risk factors for stroke.
- Assessing free protein S levels is crucial in patients with thrombotic events.
Observation:
- A study reviewed 267 patients with thrombotic strokes, referring 22 for coagulation tests.
- Free protein S antigen levels were significantly lower in women (62%) than men (88%).
- Six women exhibited low free protein S levels, with four experiencing cerebral arterial thrombosis and two venous dural sinus thrombosis.
Findings:
- Protein S deficiency was identified in six middle-aged women who suffered strokes.
- These women had significantly lower free protein S antigen levels compared to age-matched controls.
- Other coagulation abnormalities were noted in a small subset of patients.
Implications:
- Protein S deficiency may be a significant risk factor for stroke, particularly in middle-aged women.
- Further prospective studies are needed to confirm these findings in unselected populations.
- Understanding protein S deficiency's role can aid in stroke prevention strategies for at-risk women.
Abstract:
We examined the relationship between free protein S deficiency and cerebrovascular disease by reviewing the records of all patients with the diagnoses of cerebral thrombosis, cerebral embolism, and cerebral vascular occlusion who were referred for coagulation studies over a 12-month period. We assayed for free protein S antigen, protein C antigen, and antithrombin III and tested for lupus-like anticoagulant and anticardiolipin antibody. Twenty-two of 267 patients (8.2%) admitted with thrombotic strokes were referred for coagulation studies. Free protein S antigen was significantly lower in women than in men (62 +/- 25% versus 88 +/- 24%, p = 0.03; n = 11 in each group). Six women had free protein S antigen levels below the range recorded for a contemporary group of 24 age-matched normal women (17 to 59% versus 70 to 102%, p less than 0.001); four of these women had cerebral arterial thrombosis and two had venous dural sinus thrombosis. The six women were aged 29 to 55 at the time of their first strokes; two had family members with protein S deficiency, and one of these had died of a stroke at age 52. Other abnormalities in this population included a positive test for lupus-like anticoagulant or anticardiolipin in five patients, a modest decrease in protein S in two men, and one patient with an isolated deficiency of antithrombin III. We conclude that protein S deficiency may be an important risk factor for stroke in middle-aged women but this requires confirmation by prospective studies in unselected patients.