Stroke, Vol 23, 189-193, Copyright © 1992 by American Heart Association
P Nencini, MC Baruffi, R Abbate, G Massai, L Amaducci and D Inzitari
BACKGROUND AND PURPOSE: Our study evaluates in an unselected young
population with cerebral ischemia the frequency of antiphospholipid
antibodies; the relationship of antiphospholipid antibodies to conventional
risk factors for and pathological mechanisms of cerebral ischemia; and the
risk of recurrence of cerebral ischemia or systemic thrombotic events in
patients with antiphospholipid antibodies compared with those without.
METHODS: We prospectively tested for antiphospholipid antibodies in 55 of
59 young (aged 15-44 years) adults consecutively examined for ischemic
stroke (n = 44) or transient ischemic attack (n = 11). These patients
underwent a complete clinical and laboratory assessment for cerebral
ischemia and had a 3-year mean follow-up. RESULTS: Ten patients (18%), all
with stroke, had antiphospholipid antibodies. Antiphospholipid antibodies
were significantly more frequent in women than in men (Fisher's test, p =
0.014). Two patients with antiphospholipid antibodies had a new diagnosis
of systemic lupus erythematosus. On angiography, none of the patients with
antiphospholipid antibodies had extracranial lesions. Patients with
antiphospholipid antibodies had significantly more prior cerebral events
(Fisher's test, p = 0.014), and, by survival analysis, higher probability
of cerebral ischemic or systemic thrombotic events during follow-up than
patients without (log rank test, p less than 0.005). CONCLUSIONS: We
conclude that the prevalence of antiphospholipid antibodies is rather high
in young adults with cerebral ischemia; that patients with cerebral
ischemia and antiphospholipid antibodies may have unrecognized systemic
lupus erythematosus; and that, among young patients with cerebral ischemia,
patients with antiphospholipid antibodies constitute a subgroup at high
risk of cerebral ischemic or systemic thrombotic recurrence. Prevention in
this latter group may require close follow-up and treatment.
ARTICLES
Lupus anticoagulant and anticardiolipin antibodies in young adults with cerebral ischemia
Department of Neurological and Psychiatric Sciences, University of Florence, Italy.
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