Thromb Haemost 2004; 91(05): 1031-1034
DOI: 10.1160/TH03-11-0690
Cell Signaling and Vessel Remodeling
Schattauer GmbH

Factor V Leiden and prothrombin G20210A mutations in young adults with cryptogenic ischemic stroke

Justo Aznar
1   Department of Clinical Pathology, La Fe University Hospital, Valencia, Spain
,
Yolanda Mira
1   Department of Clinical Pathology, La Fe University Hospital, Valencia, Spain
,
Amparo Vayá
1   Department of Clinical Pathology, La Fe University Hospital, Valencia, Spain
,
Dolores Corella
2   Molecular Epidemiology Unit, School of Medicine University of Valencia, Spain
,
Fernando Ferrando
1   Department of Clinical Pathology, La Fe University Hospital, Valencia, Spain
,
Piedad Villa
1   Department of Clinical Pathology, La Fe University Hospital, Valencia, Spain
,
Amparo Estellés
3   Research Center, La Fe University Hospital, Valencia, Spain
› Author Affiliations
Further Information

Publication History

Received 13 November 2003

Accepted after resubmission 16 February 2004

Publication Date:
01 December 2017 (online)

Summary

The association between factor V Leiden (FVL) and prothrombin G20210A (PT 20210) mutations and ischemic stroke remains controversial, particularly in young adults with cryptogenic stroke. Prevalence of FVL (4.1%) and PT 20210 (8.2%) mutations was assessed in 49 patients under 50 years with cryptogenic stroke and compared with controls. Odd ratio (OR) for cryptogenic stroke was 2.62 (95% CI, 0.49-13.95) for FVL and 3.75 (95% CI, 1.05-13.34) for PT 20210 and 3.28 (95% CI, 1,17-9.20) for some recognized genetic thrombophilic defect. Moreover, the OR for cryptogenic stroke in young women using oral contraceptives (OC) was 3.59 (95% CI, 1.28-10.5). When some genetic thrombophilic defect was associated with OC, the OR was much higher (OR: 14.27; 95% CI, 0.66-309.99). Our results suggest that in the Mediterranean populations the PT 20210 mutation, but not FV Leiden, is a risk factor for cryptogenic stroke in young adults. OC use is also a significant risk factor for cryptogenic stroke, which is increased in women with some genetic thrombotic risk factor.

 
  • References

  • 1 Ridker PM, Hennekens CH, Lindpaintner K. et al. Mutation in the gene coding for coagulation factor V and the risk of myocardial infarction, stroke, and venous thrombosis in apparently healthy men. N Engl J Med 1995; 332: 912-7.
  • 2 Kontula K, Ylikorkala A, Miettinen H. et al. Arg506Gln factor V mutation (Factor V Leiden) in patients with ischemic cerebrovascular disease and survivors of myocardial infarction. Thromb Haemost 1995; 73: 558-60.
  • 3 Catto A, Carter A, Ireland H. et al. Factor V Leiden gene mutation and thrombin generation in relation to the development of stroke. Arterioscler Thromb Vasc Biol 1995; 15: 783-5.
  • 4 Zuber M, Toulon P, Mas JL. Resistance to activated protein C in cerebral thromboembolism: a case control study. Cerebrovascular Dis 1995; 05: 189 Abstract.
  • 5 Press RD, Liu XY, Beamer N. et al. Ischemic stroke in the elderly: role of the common factor V mutation causing resistance to activated protein C. Stroke 1996; 27: 44-8.
  • 6 Sánchez J, Román J, de la Torre MJ. et al. Low prevalence of factor V Leiden among patients with ischemic stroke. Haemostasis 1997; 27: 9-15.
  • 7 Cushman M, Rosendaal FR, Psaty BM. et al. Factor V Leiden is not a risk factor for arterial vascular disease in the elderly: results from the Cardiovascular Health Study. Thromb Haemost 1998; 79: 912-5.
  • 8 Juul K, Tybjaerg-Hansen A, Steffensen R. et al. Factor V Leiden: The Copenhagen City Heart Study and 2 meta-analyses. Blood 2002; 100: 3-10.
  • 9 Corral J, Gónzalez-Conejero R, Lozano ML. et al. The venous thrombotic risk factor 20210 A allele of the prothrombin gene is not a major risk factor for arterial thrombotic disease. Br J Haematol 1997; 99: 304-7.
  • 10 Martinelli I, Franchi F, Akwan S. et al. The transition G to A at position 20210 in the 3’untranslated region of the prothrombin gene is not associated with cerebral ischemia. Blood 1997; 90: 3806.
  • 11 Wu AHB, Tsongalis GJ. Correlation of polymorphisms to coagulation and biochemical risk factors for cardiovascular diseases. Am J Cardiol 2001; 87: 1361-6.
  • 12 De Stefano V, Chiusolo P, Paciaroni K. et al. Prothrombin G20210A mutant genotype is a risk factor for cerebrovascular ischemic disease in young patients. Blood 1998; 91: 3562-5.
  • 13 Nowak-Göttl U, Sträter R, Dübbers A. et al. Ischaemic stroke in infancy and childhood: role of the Arg506 to Gln mutation in the factor V gene. Blood Coagul Fibrinolysis 1996; 07: 684-8.
  • 14 Ganesan V, Kelsey H, Cookson J. et al. Activated protein C resistance in childhood stroke. Lancet 1996; 347: 260.
  • 15 Zenz W, Bodó Z, Plotho J. et al. Factor V Leiden and prothrombin gene G20210A variant in children with ischemic stroke. Thromb Haemost 1998; 80: 763-6.
  • 16 Riikonen RS, Vahtera EM, Kekomäki RM. Physiological anticoagulants and activated protein C resistance in childhood stroke. Acta Pediatr 1996; 85: 242-4.
  • 17 Albucher JF. Frequency of resistance to activated protein C due to Factor V mutation in young patiens with ischemic stroke. Stroke 1996; 27: 766-7.
  • 18 Margaglione M, D’Andrea G, Giuliani N. et al. Inherited prothrombotic conditions and premature ischemic stroke. Sex difference in the association with factor V Leiden. Arterioscler Thromb Vasc Biol 1999; 19: 1751-6.
  • 19 Grossman R, Geisen U, Merati G. et al. Genetic risk factors in young adults with “cryptogenic” ischemic cerebrovascular disease. Blood Coagul Fibrinolysis 2002; 13: 583-90.
  • 20 Nabavi DG, Junker R, Wolff E. et al. Prevalence of factor V Leiden mutation in young adults with cerebral ischaemia: a case-control study on 225 patients. J Neurol 1998; 245: 653-8.
  • 21 Pezzini A, Elisabetta Z, Magoni M. et al. Inherited thrombophilic disorders in young adults with ischemic stroke and patent foramen ovale. Stroke 2003; 34: 28-33.
  • 22 Kontula K, Ylikorkala A, Miettinen H. et al. Arg506Gln factor V mutation and (factor V Leiden) in patients with ischaemic cerebrovascular disease and survivors of myocardial infarction. Thromb Haemost 1995; 73: 558-60.
  • 23 Landi G, Cella E, Martinelli I. et al. Arg506Gln factor V mutation and cerebral ischemia in the young. Stroke 1996; 27: 1697-8.
  • 24 Halbmayer WM, Haushofer A, Angerer V. et al. APC resistance and factor V Leiden (FV: Q506) mutation in patients with ischemic cerebral events. Blood Coagul Fibrinolysis 1997; 08: 361-4.
  • 25 Longstreth WT, Rosendaal FR, Siscovick DS. et al. Risk of stroke in young women and two prothrombotic mutations: factor V Leiden and prothrombin gene variant (G20210A). Stroke 1998; 29: 577-80.
  • 26 Voetsch B, Damasceno BP, Camargo ECS. et al. Inherited thrombophilia as a risk factor for the development of ischemic stroke in young adults. Thromb Haemost 2000; 83: 229-33.
  • 27 Austin H, Chimowitz MI, Hill HA. et al. for the Genetics and Stroke in the Young Study Group. Cryptogenic stroke in relation to genetic variation in clotting factors and other genetic polymorphisms among young men and women. Stroke 2002; 33: 2762-9.
  • 28 Bushell CD, Goldstein LB. Diagnostic testing for coagulopathies in patients with ischemic stroke. Stroke 2000; 31: 3067-78.
  • 29 Bentolila S, Ripoll L, Drouet L. et al. Thrombophilia due to 20210 G A prothrombin polymorphism and cerebral ischemia in the young. Stroke 1997; 28: 1846-7 Letter.
  • 30 Szolnoki Z, Somogyvari F, Kondacs A. et al. Evaluation of the interactions of common genetic mutations in stroke subtypes. J Neurol 2002; 249: 1391-7.
  • 31 Szolnoki Z, Somogyvari F, Kondacs A. et al. Evaluation of the modifying effects of unfavourable genotypes on classical clinical risk factors for ischaemic stroke. J Neurol Neurosurg Psychiatry 2003; 74: 1615-20.
  • 32 Karttunem V, Hiltunen L, Rasi V. et al. Factor V Leiden and prothrombin gene mutation may predispose to paradoxical embolism in subjects with patent foramen ovale. Blood Coagul Fibrinolysis 2003; 14: 261-8.
  • 33 Hegele RA. Genetic association studies of stroke: hope, signal and noise. Stroke 2002; 33: 2769.
  • 34 Villa P, Aznar J, Vayá A. et al. Hereditary homozygous heparin cofactor II deficiency and the risk developing venous thrombosis. Thromb Haemost 1999; 82: 1011-4.
  • 35 Gandrille S, Alhenc-Gelas M, Aiach M. A rapid screening methods for the factor V Arg 506 Gln mutation. Blood Coagul Fibrinolysis 1995; 06: 245-8.
  • 36 Poort SR, Rosendaal FR, Reitsma PH, Bertina RM. A common genetic variation in the 3’-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and increase in venous thrombosis. Blood 1996; 88: 3698-03.
  • 37 Rees DC. The population genetics of factor V Leiden (Arg506Gln). Br J Haematol 1996; 95: 579-86.
  • 38 Rosendaal FR, Doggen CJ, Zivelin A. et al. Geographic distribution of the 20210 G to A prothrombin variant. Thromb Haemost 1998; 79: 706-8.
  • 39 Aznar J, Vayá A, Estellés A. et al. Risk of venous thrombosis in carriers of the prothrombin G20210A variant and factor V Leiden and their interaction with oral contraceptives. Haematologica 2000; 85: 1271-6.
  • 40 Gillum LA, Mamidipudi SK, Johnston SC. Ischemic stroke risk with oral contraceptives. A Meta-analysis. JAMA 2000; 284: 72-8.