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Antiphospholipid antibodies and cerebral ischemia in young people
R L Brey1, R G Hart, D G Sherman
1Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio 78284.
Insights
Antiphospholipid antibodies (aPL) are linked to ischemic stroke in young adults. These antibodies, including anticardiolipin antibody (aCL) and lupus anticoagulants (LA), may indicate a prothrombotic state contributing to recurrent events.
Area of Science:
- Neurology
- Immunology
- Vascular Medicine
Background:
- The role of prothrombotic states in young adult ischemic stroke is not well understood.
- Antiphospholipid antibodies (aPL), such as anticardiolipin antibody (aCL) and lupus anticoagulants (LA), are potential contributors.
Purpose of the Study:
- To investigate the association between aCL/LA and cerebral ischemia in patients under 50.
- To determine if aCL/LA presence is specific to cerebral ischemia compared to other neurological diseases.
Main Methods:
- Studied 46 young patients (<50 years) with cerebral ischemia over 3 years.
- Assessed for anticardiolipin antibody (aCL) and lupus anticoagulants (LA).
- Used age- and sex-matched controls with other neurologic diseases for comparison.
Main Results:
- 21 out of 46 stroke/TIA patients had aCL or LA; 2 out of 26 control patients had aCL.
- aPL presence was not linked to other stroke risk factors in stroke/TIA patients.
- Patients with aPL and cerebral ischemia experienced more recurrent events.
Conclusions:
- Antiphospholipid antibodies (aPL) are found more frequently in young patients with stroke/TIA.
- aPL-associated prothrombotic state may be crucial for recurrent ischemia in patients with underlying conditions.
- aPL presence in young stroke patients is often independent of systemic lupus diagnosis.
Abstract:
The importance of a prothrombotic state as a cause of ischemic stroke in young adults is ill defined. We examined 46 unselected patients under age 50 years with cerebral ischemia for anticardiolipin antibody (aCL) and lupus anticoagulants (LA), over a 3-year-period. Age- and sex-matched patients with other neurologic diseases served as a noncerebral ischemia comparison group to test whether (1) stroke/transient ischemic attacks (TIA) in young people is associated with aCL and/or LA, and (2) their presence is specific to cerebral ischemia. In the stroke/TIA group, 21 patients had aCL or LA and 25 had neither, whereas in the control group, 2 patients had aCL and 24 had neither. Equal numbers of stroke/TIA patients with and without antiphospholipid antibodies (aPL) had other stroke risk factors. Patients with aPL and cerebral ischemia, however, had a more frequent history of multiple events than those without them. These antibodies occur with undue frequency in young patients with stroke/TIA and are not associated with a concurrent diagnosis of systemic lupus in most cases. A coexistent aPL-associated prothrombotic state may be a key determinant of whether patients with atherosclerosis, mitral valve prolapse, or other structural lesions experience recurrent ischemia.