Clinical outcomes and a high prevalence of abnormalities on comprehensive arterial and venous thrombophilia screening in TIA or ischaemic stroke patients with a patent foramen ovale, an inter-atrial septal aneurysm or both
Research article published in Journal of the neurological sciences (2017)
Abstract
INTRODUCTION: Data are limited on the optimal management of cryptogenic TIA/stroke patients with a patent foramen ovale (PFO)±inter-atrial septal aneurysm (IASA), especially with an inherited thrombophilia. METHODS: Prospectively-collected data on TIA/ischaemic stroke patients with PFO, IASA or both who received 'goal-directed secondary-prevention medical treatment' were analysed. All patients had trans-oesophageal echocardiography, anti-nuclear, anti-cardiolipin, anti-beta 2 glycoprotein I antibodies, rheumatoid factor, lupus anticoagulant, protein C&S, anti-thrombin, factor VIII activity, activated protein C resistance, Factor V Leiden, prothrombin gene and MTHFR-c.677C>T mutation screening. ENA and homocysteine were assessed in the latter study period. RESULTS: Eighty-three patients were recruited. Mean follow-up: 48.1months. Forty-seven patients (56.6%) had an isolated PFO, 32 (38.6%) a PFO and an IASA, and 4 (4.8%) an IASA alone. Eighteen (21.7%) had ≥1 abnormality on thrombophilia screening. The most important abnormalities which lead to treatment changes in 11 patients (13.3%) were primary anti-phospholipid syndrome (N=3; 3.6%), protein S deficiency (N=2; 2.4%) hyper-homocysteinaemia (N=6/72 screened, 8.3%). Four patients (4.8%) opted for PFO closure: two with protein S deficiency, and two with no identified thrombophilia. Seven (8.4%) had recurrent TIA/ischaemic stroke during follow-up (overall annualised incidence: 2.1%), of whom five had a PFO alone and two a PFO and IASA. DISCUSSION: Comprehensive arterial and venous thrombophilia screening is warranted in TIA/ischaemic stroke patients with a PFO±IASA, is conclusively abnormal in over a fifth, and informed important decision-making regarding individualised therapy in 13.3% of patients. The incidence of recurrent vascular events in this population is low on optimal, personalised secondary-prevention treatment, even with an underlying thrombophilia.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
In 83 TIA/ischaemic stroke patients with PFO or inter-atrial septal aneurysm followed for 48.1 months, 21.7% had thrombophilia abnormalities. Recurrent events occurred in 8.4% (annualized 2.1%) under goal-directed secondary prevention, with treatment changes informed in 13.3%.
Why This Matters for Hirudotherapy
This prospective study examined 83 TIA/ischaemic stroke patients with a patent foramen ovale (PFO)±inter-atrial septal aneurysm (IASA) who underwent comprehensive arterial and venous thrombophilia screening while receiving goal-directed secondary-prevention treatment (mean follow-up 48.1 months). For ASH, the work is relevant because thrombophilia screening identifies patients who may require intensified anticoagulation — the therapeutic domain where leech-derived hirudin and its analogs (lepirudin, desirudin, bivalirudin) serve as direct thrombin inhibitors — and 21.7% of these patients had ≥1 clotting abnormality, with 13.3% having findings that directly altered management. The overall annualised recurrence rate of stroke/TIA was 2.1% on personalised treatment. An honest caveat: this was an observational study without a comparator group, so it cannot prove that screening improved outcomes, and it provides no data on any specific anticoagulant, including hirudin-class agents.
Citation
Clinical outcomes and a high prevalence of abnormalities on comprehensive arterial and venous thrombophilia screening in TIA or ischaemic stroke patients with a patent foramen ovale, an inter-atrial septal aneurysm or both.
Lim ST et al. · Journal of the neurological sciences, 2017
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