Migraine and hypercoagulable states in ischemic stroke

Background: Whether migraine is associated with a higher prevalence of hypercoagulable states (HS) in ischemic stroke patients is unknown. Methods: This was a prospective study of patients under 55 years of age with brain ischemia. A systematic questionnaire addressed the antecedent of migraine with aura (MA) or without aura (MO). We investigated the presence of HS by an extensive battery of haematological tests. The presence of patent foramen ovale (PFO) was assessed by trans-oesophageal echocardiography. Results: A total of 154 patients (95 men; mean ± SD age, 44.12 ± 8.4 years) were included; 44 had migraine, 15 had MA. HS were more frequent in the migraine than non-migraine group (38.6% vs. 16.4%, p < 0.01). The multivariate analysis showed that MO was associated with a 2.88-fold (95% CI, 1.14 to 7.28) increased risk of HS diagnosis. However, in the group of patients with brain infarction under 50 years old, MA, but not MO, was independently associated with HS (OR 6.81; 95% CI, 1.01 to 45.79). Conclusion: In young patients with ischemic stroke, migraine may be associated with a higher frequency of HS.

Download Full-text

The research of the relationships between patent foramen ovale and ischemic stroke in elderly patients

10.21203/rs.3.rs-23628/v1 ◽

2020 ◽

Author(s):

Xu Chao Sun ◽

Wenjing Jiang ◽

Yan Zhao ◽

Lin Ma ◽

Yan Lin ◽

...

Keyword(s):

Ischemic Stroke ◽

Elderly Patients ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Young Patients ◽

Test Group ◽

Control Group ◽

Foramen Ovale ◽

Stroke Patients ◽

Shunt Volume

Abstract Background Research indicates that abnormal embolism caused by patent foramen ovale (PFO) may play an important role in cryptogenic stroke (CS). However, most researches has focused on young patients, and whether abnormal embolism caused by PFO also plays an important role in elderly CS is uncertain. The purpose of this study is to analyze the clinical characteristics of elderly patients with PFO, and to explore the correlation between elderly PFO and ischemic stroke.Methods 62 elderly patients diagnosed with ischemic stroke admitted to Qilu Hospital of Shandong University from April 2014 to April 2019 were selected as the Test Group. 62 non-stroke patients in our hospital's physical examination center and outpatient clinic were selected as the Control Group. Collect clinical data of patients for retrospective analysis.Results The incidence of PFO in the Test Group was significantly higher than that in the Control Group, the difference was statistically significant (p < 0.05). The proportion of large and medium shunt patients in the Test Group was significantly higher than that in the Control Group (p < 0.05). The proportion of patients with migraine in the PFO (+) group in the Test Group was significantly higher than the stroke patients in the PFO (-) group (p < 0.05).Conclusions The shunt volume of the PFO is related to ischemic stroke and may be a risk factor for ischemic stroke.

Download Full-text

Abstract 2922: Patent Foramen Ovale Is A Cause Of Ischemic Stroke In Patients With Antiphospholipid Syndrome

Stroke ◽

10.1161/str.43.suppl_1.a2922 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Yoshiaki Shimada

Keyword(s):

Ischemic Stroke ◽

Antiphospholipid Syndrome ◽

Patent Foramen Ovale ◽

Multiple Logistic Regression Analysis ◽

Cryptogenic Stroke ◽

Control Group ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Stroke Patients ◽

Significant Difference

Background: The antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of arterial and/or venous thrombosis and recurrent fetal loss, and can be an independent risk factor for a first-ever ischemic stroke especially in young female patients. Patent foramen ovale (PFO) has been established as a cause of cryptogenic stroke. Atrial septal aneurysm (ASA) is associated with PFO. Until recently, the precise pathophysiology of APS as causing ischemic stroke has been essentially unknown. In the present study, we investigated the relationship between APS and potential embolic sources including PFO and ASA using transesophageal echocardiography (TEE). Methods: This study was a retrospective case series design. From July 2006 to June 2008, 120 patients with ischemic stroke who admitted to Juntendo University Hospital underwent TEE. In this study period, consecutive ischemic stoke patients diagnosed as APS based on the modified Sapporo criteria were enrolled and classified into APS group. Controls were selected among age- and gender-matched stroke patients without APS who also underwent TEE. We assessed clinical characteristics and presence of embolic sources including PFO and atrial septal aneurysm (ASA) between APS and Control groups. Results: Nine of ischemic stroke patients with APS and 41 controls were included. Primary APS was present in one patient (11.1%) of the APS group, and APS with SLE were found in eight patients (88.9%). There is no significant difference in age, risk factors for ischemic stroke, and MRI findings between two groups. The prevalence of PFO and ASA were significantly higher in APS group compared to Control group (89% vs 41%, P=0.027; 67% vs 20%, P=0.015, respectively). C reactive protein was relatively higher in APS group. Multiple logistic regression analysis showed that PFO (OR: 13.71; 95% CI: 1.01 to 185.62; P=0.049) and ASA (OR: 8.06; 95% CI: 1.17 to 55.59; P=0.034) were independently associated with the APS group. Conclusion: Atrial septal abnormalities including PFO and ASA are strongly associated with APS group, and could be potential embolic sources in ischemic stroke patients with APS.

Download Full-text

INCREASED RISK OF PERIOPERATIVE ISCHEMIC STROKE IN PATIENTS WHO UNDERGO NON-CARDIAC SURGERY WITH PREEXISTING PATENT FORAMEN OVALE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31230-6 ◽

2019 ◽

Vol 73 (9) ◽

pp. 622

Author(s):

Pedro Arturo Villablanca ◽

Alejandro Lemor ◽

Tanush Gupta ◽

Divyanshu Mohananey ◽

Pablo Michel ◽

...

Keyword(s):

Cardiac Surgery ◽

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Foramen Ovale ◽

Increased Risk

Download Full-text

Prevalence of Patent Foramen Ovale in Migraine Patients with and Without Aura Compared with Stroke Patients. A Transcranial Doppler Study

Cephalalgia ◽

10.1111/j.1468-2982.2006.01156.x ◽

2006 ◽

Vol 26 (8) ◽

pp. 934-939 ◽

Cited By ~ 54

Author(s):

FJ Carod-Artal ◽

L da Silveira Ribeiro ◽

H Braga ◽

W Kummer ◽

HM Mesquita ◽

...

Keyword(s):

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Transcranial Doppler Sonography ◽

Young Patients ◽

Data Bank ◽

Foramen Ovale ◽

Stroke Patients ◽

Doppler Study ◽

The Difference

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7± in migraine with aura (MA) patients, 33.7± in migraine without aura (MoA) patients, 33.8± in young stroke patients and 20.5± in elderly stroke patients ( P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1± and 25± ( P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.

Download Full-text

Race-Ethnic Differences in Patent Foramen Ovale, Atrial Septal Aneurysm, and Right Atrial Anatomy Among Ischemic Stroke Patients

Stroke ◽

10.1161/01.str.0000085828.67563.42 ◽

2003 ◽

Vol 34 (9) ◽

pp. 2097-2102 ◽

Cited By ~ 35

Author(s):

Carlos J. Rodriguez ◽

Shunichi Homma ◽

Ralph L. Sacco ◽

Marco R. Di Tullio ◽

Robert R. Sciacca ◽

...

Keyword(s):

Ischemic Stroke ◽

Ethnic Differences ◽

Patent Foramen Ovale ◽

Right Atrial ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Stroke Patients

Download Full-text

Patent Foramen Ovale in Young Patients with Ischemic Stroke

Turkish Journal of Cerebrovascular Diseases ◽

10.5505/tbdhd.2018.21548 ◽

2018 ◽

Vol 24 (2) ◽

pp. 46-51

Author(s):

Zeynep Özözen Ayas ◽

Aslı Aksoy Gündoğdu ◽

Çağın Mustafa Üreyen

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Young Patients ◽

Foramen Ovale

Download Full-text

Abstract 1173: Risk of Recurrent Cerebrovascular Events in Patients with Cryptogenic Cerebral Ischemia and Patent Foramen Ovale: A Meta-Analysis of Observational Studies

Circulation ◽

10.1161/circ.118.suppl_18.s_653 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Stephen B Wilton ◽

Mohammed A Almekhlafi ◽

Doreen M Rabi ◽

William A Ghali ◽

Diane L Lorenzetti ◽

...

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Recurrent Events ◽

Comparison Group ◽

Meta Analysis ◽

Cryptogenic Stroke ◽

Absolute Rate ◽

Foramen Ovale ◽

Cerebrovascular Events ◽

Increased Risk

In patients with a patent foramen ovale (PFO) and a prior cryptogenic ischemic stroke or transient ischemic attack (TIA), the risk of recurrent events is unclear. To conduct a systematic review and meta-analysis of studies assessing the risk of recurrent cerebrovascular events in patients with cryptogenic cerebral ischemia and PFO. MEDLINE (1950 to February 2008) and EMBASE (1980 to February 2008) databases were searched to identify studies in any language. Searches were supplemented by scanning bibliographies of key articles. Studies reporting original data on recurrent cerebrovascular events in patients with prior cryptogenic stroke or TIA and PFO, with or without a non-PFO comparison group, were included. Uncontrolled case series evaluating device or surgical closure of PFO were excluded. Two authors independently extracted the data from included studies and evaluated study quality. For studies with a non-PFO comparison group, relative risks were pooled using a fixed effects model after confirming homogeneity of results. For all studies, the pooled absolute rate of recurrent events was calculated using a random effects model due to heterogeneity of results. Fifteen studies published between 1994 and 2007, following 2377 patients over a mean of 37 months were included. In the four studies with a non-PFO comparison group, the pooled relative risk of recurrent stroke or TIA associated with the presence of a PFO was 1.1 (95% CI 0.8 to 1.5), while for recurrent ischemic stroke the pooled relative risk associated with the presence of a PFO was 0.8 (95% CI 0.5 to 1.3). The pooled absolute rate of recurrent ischemic stroke or TIA in patients with PFO was 4.0 events per 100 person-years (95% CI 3.0 to 5.1) while the rate of recurrent ischemic stroke was 1.6 events per 100 person years (95% CI 1.1 to 2.1). No clinical or imaging features are reliably associated with increased risk of recurrent events. In medically treated patients with prior cryptogenic stroke, available evidence does not support an increased risk of recurrent ischemic events in those with vs. without a PFO. Routine PFO closure in these patients may not be warranted, outside of ongoing clinical trials.

Download Full-text

Abstract 170: Role of Patent Foramen Ovale in First and Recurrent Childhood Cryptogenic Arterial Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.170 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Evelyn K Shih ◽

Shobha Natarajan ◽

Christine Falkensammer ◽

Lauren A Beslow ◽

Steven R Messe ◽

...

Keyword(s):

Ischemic Stroke ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Stroke Recurrence ◽

Atrial Septal Aneurysm ◽

Control Analysis ◽

Foramen Ovale ◽

Arterial Ischemic Stroke ◽

Stroke Patients ◽

Retrospective Case

Background: Numerous studies in adults have reported a robust association between patent foramen ovale (PFO) and cryptogenic arterial ischemic stroke (AIS), particularly in younger adults. The association between PFO and stroke in children has not been well characterized and the clinical significance of identifying a PFO in a child with first or recurrent cryptogenic stroke is currently unknown. Methods: We performed a retrospective case control analysis of a 10-year prospectively enrolled cohort of children with acute AIS who underwent transthoracic echocardiogram (TTE) as part of their diagnostic evaluation. We compared PFO prevalence in children with cryptogenic stroke to those with known stroke etiologies and to non-stroke controls. We also assessed stroke recurrence risk in children with vs without PFO and assessed PFO features that may confer higher stroke risk. Results: Of 119 children with first-ever AIS, 59 had TTE available for central review, of which 17 were cryptogenic and 42 had a known cause. PFO prevalence was higher in the cryptogenic stroke group (X, 24%) compared to both the known stroke etiology group (Y, 6%, p = 0.05) and non-stroke controls (Z, 8%, p = 0.05). However, 2 year recurrence free survival rates in stroke patients with PFO did not differ from those without PFO (HR 1.58, 95% CI 0.18-13.62, p = 0.68). PFOs in children with AIS vs controls had numerically more right-to-left shunt at rest (7 vs 0) and atrial septal aneurysm (4 vs 0) but the study was underpowered to look at these factors. Conclusions: In our prospectively enrolled cohort of children with AIS, we found the prevalence of PFO to be higher in children with cryptogenic stroke compared to healthy controls and non-cryptogenic stroke patients. The implication of PFO for risk of recurrence and optimal secondary preventative treatment remains uncertain and require further study.

Download Full-text

A model of multi-disciplinary approach to the diagnosis and treatment of young patients with cryptogenic stroke and patent foramen ovale

Cardiology in the Young ◽

10.1017/s1047951112000029 ◽

2012 ◽

Vol 22 (3) ◽

pp. 327-334 ◽

Cited By ~ 8

Author(s):

Sara Mazzucco ◽

Paolo Bovi ◽

Monica Carletti ◽

Giampaolo Tomelleri ◽

Giorgio Golia ◽

...

Keyword(s):

Clinical Practice ◽

Medical Therapy ◽

Patent Foramen Ovale ◽

Recurrent Events ◽

Scientific Evidence ◽

Cryptogenic Stroke ◽

Young Patients ◽

Foramen Ovale ◽

Stroke Patients ◽

Therapeutic Decisions

AbstractBackgroundTreatment of patent foramen ovale in young patients with stroke is not supported by robust scientific evidence. In clinical practice, a pragmatic approach is needed to guide such therapeutic decisions. This study aims at standardising the diagnostic pathway for stroke patients younger than 55 years of age with a patent foramen ovale; elaborating a therapeutic algorithm; discussing every case in regular interdisciplinary counselling meeting; and setting up a follow-up schedule to assess clinical outcomes.MethodsThis is a cohort study on the effect of a standardised treatment of stroke patients with a patent foramen ovale. The primary endpoints include occurrence of recurrent ischaemic events, major bleeding, and device-related complications. The secondary endpoints include drug- or procedure-related side effects, persistence of right-to-left shunt, and persistent cardiac arrhythmia of new onset.ResultsA total of 103 patients have been enrolled. In all, 51 patients underwent percutaneous atrial septal repair; of these, one had minor post-procedural bleeding. At 12 months, 25% of this group of patients showed a latent I grade shunt, one patient a latent II degree shunt, and none had a persistent shunt. The remaining 52 patients were addressed to medical therapy; one of them experienced stroke recurrences while on medical therapy.ConclusionsThis model of implementation of available evidence to clinical practice via a group-based, multi-disciplinary counselling provides a shared and coherent decision pathway and yielded a very low rate of recurrent events and therapy-related complications. This approach could be replicated in specific protocols for other complex or neglected clinical problems.

Download Full-text

Prevalence of Thrombophilia in Transient Ischemic Attack and Ischemic Stroke Patients

Blood ◽

10.1182/blood-2020-133476 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 3-3

Author(s):

Omar Raslan ◽

Christopher Tran ◽

Fatimah Al-Ani ◽

Luciano Sposato ◽

Alejandro Lazo-Langner

Keyword(s):

Ischemic Stroke ◽

High Risk ◽

Transient Ischemic Attack ◽

Patent Foramen Ovale ◽

Research Funding ◽

Transient Ischemic Attacks ◽

Foramen Ovale ◽

Stroke Patients ◽

Thrombophilia Screening ◽

Ischemic Attack

Introduction. Screening for inherited thrombophilia has been recommended in patients with cryptogenic ischemic strokes and anticoagulant therapy is frequently indicated based on these results. However, current evidence suggests that thrombophilia screening is over utilized in stroke patients and may provide more risks than benefits. Patients and Methods.We conducted a retrospective cohort study in patients with transient ischemic attack (TIA) or ischemic stroke who had a thrombophilia screen and determined the proportions of each thrombophilia trait, and the proportion of high risk thrombophilia in this population. Pre-specified subgroup analyses were conducted for patients with ischemic stroke and transient ischemic attacks, and for patients with patent foramen ovale. Results.We included 412 patients (152 male and 260 female). The prevalence of thrombophilia was 7.52% (95% CI 5.35-10.48). The proportion of major thrombophilia was 2.18 (95% CI=1.15 - 4.09). The proportion of thrombophilia traits in ischemic stroke patients was lower 4.92% (95% CI 2.61 - 9.08) than that in patients with transient ischemic attacks 9.57% (95% CI = 6.41 - 14.06); Only 2 individuals had both a positive thrombophilia screen and a patent foramen ovale. Discussion. In this study the prevalence of thrombophilia traits in patients with ischemic stroke or transient ischemic attack was low, including high risk thrombophilic traits. Further studies are needed to determine if thrombophilia screening exposes these patients to additional risks without any benefits. Disclosures Sposato: Western University:Other: Kathleen and Dr. Henry Barnett Chair in Stroke Research;Boehringer Ingelheim:Honoraria, Research Funding;Pfizer:Honoraria, Research Funding;Gore:Honoraria, Research Funding;Bayer:Honoraria, Research Funding.

Download Full-text