Paciente joven con accidente cerebrovascular isquémico: ¿Se debe buscar una trombofilia?


Autores/as

DOI:

https://doi.org/10.22517/25395203.24715

Palabras clave:

ACV agudo, Paciente joven, Trombofilia

Resumen

El accidente cerebrovascular isquémico es un evento de gran importancia debido a las implicaciones y el impacto en la calidad de vida de la población afectada. Su incidencia es más alta en adultos mayores y en personas con factores de riesgo cardiovascular. Existe un grupo de pacientes jóvenes (18-44 años) sin factores de riesgo que presentan dicho evento, por lo que, en la práctica clínica, se tiende a evaluar rutinariamente las trombofilias hereditarias y adquiridas como factor etiológico principal para los eventos isquémicos en este grupo etario. No obstante, son pocos los casos donde se documenta algún trastorno de este tipo, ya que es más frecuente la presencia de otras etiologías como el cardioembolismo y trastornos vasculares. La evaluación de las trombofilias es compleja, dado el alto costo, las limitaciones técnicas para hacerlo y el impacto clínico y terapéutico incierto al documentarse estos estados. Se realiza esta revisión de tema con el fin de orientar al clínico acerca de la pertinencia de objetivar estas condiciones en el paciente joven con accidente cerebrovascular isquémico.  

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

Juan David Orozco Burbano, Md., Universidad del Cauca

Médico

Especialista en medicina interna

Diana Carolina Urbano Albán, Md., Hospital Universitario de San José de Popayán

Médica

Tomás Ómar Zamora Bastidas, Md., Universidad del Cauca

Médico

Especialista en Neurología

Profesor, Universidad del Cauca

Citas

Ovbiagele B, Nguyen-Huynh MN. Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy. Neurotherapeutics. 2011;8(3):319–29.

Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: A global perspective. J. Neurol. Neurosurg. Psychiatry; 2020 91(4):411-417. doi: 10.1136/jnnp-2019-322424

Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation; 2019, 139, 56–528.

Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, de Leeuw FE. Epidemiology, aetiology, and management of ischemic stroke in young adults. Lancet Neurol 2018; 17:790–801. doi: 10.1016/S1474-4422(18)30233-3

Hankey GJ, Eikelboom JW, Van Bockxmeer FM, Lofthouse E, Staples N, Baker RI. Inherited thrombophilia in ischemic stroke and its pathogenic subtypes. Stroke. 2001;32(8):1793–9.

Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw F-E, Tuladhar AM. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry. 2020;91(4):411–7

Chung JW, Park SH, Kim N, Kim WJ, Park JH, Ko Y, et al. Trial of ORG 10172 in acute stroke treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging. J Am Heart Assoc. 2014;3(4):1–9.

Aguilera-Pena MP, Cardenas-Cruz AF, Baracaldo I, Garcia-Cifuentes E, Ocampo-Navia MI, Coral EJ. Ischemic stroke in young adults in Bogota, Colombia: a cross-sectional study. Neurol Sci. 2021;42(2):639–45

Schöberl F, Ringleb PA, Wakili R, Poli S, Wollenweber FA, Kellert L. Juvenile stroke-a practice-oriented overview. Dtsch Arztebl Int. 2017;114(31–32):527–34.

Kittner SJ, Stern BJ, Wozniak M, et al. Cerebral infarction in young adults: the Baltimore-Washington Cooperative Young Stroke Study. Neurology. 1998; 50(4):890–894. doi: 10.1212/wnl.50.4.890

Tapia, J. Enfermedad cerebrovascular y trombofilia. Rev. chilena. neuro-psiquiatría; 2002,40 (2), p.37-45. doi.org/10.4067/S0717-92272002000200004

Montanaro VVA, Freitas DDS, Ruiz MCM, Cavalcanti EBU, Marinho PBC, Freitas MCDNB, et al. Ischemic stroke in young adults: Profile of SARAH hospital Brasília from 2008 to 2012. Neurologist. 2017;22(2):61–3.

Gallo D, Del Carmen M, Sánchez Luceros D, Dra Altuna A, Ceresetto D, Fassi J, et al. Hemostasia y Trombosis. Guías de Diagnóstico y Tratamiento. Sociedad Argentina de Hematología. Trombofilias. 2017 p. 229-238.

Chiasakul T, De Jesus E, Tong J, Chen Y, Crowther M, Garcia D, et al. Inherited Thrombophilia and the Risk of Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019;8(19).

Hathidara MY, Saini V, Malik AM. Stroke in the Young: a Global Update. Curr Neurol Neurosci Rep. 2019;19(11).

Omran SS, Lerario MP, Gialdini G, Merkler AE, Moya A, Chen ML, et al. Clinical Impact of Thrombophilia Screening in Young Adults with Ischemic Stroke. J Stroke Cerebrovasc Dis 2019;28(4):882–9. doi.org/10.1016/j.jstrokecerebrovasdis.2018.12.006

Gavva C, Johnson M, De Simone N, Sarode R. An Audit of Thrombophilia Testing in Patients with Ischemic Stroke or Transient Ischemic Attack: The Futility of Testing. J Stroke Cerebrovasc Dis.2018;27(11):3301–5. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.07.032

Crespo Pimentel B, Willeit J, Töll T, Kiechl S, Pinho e Melo T, Canhão P, et al. Etiologic Evaluation of Ischemic Stroke in Young Adults: A Comparative Study between Two European Centers. J Stroke Cerebrovasc Dis. 2019;28(5):1261–6.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2018, 49 (3) p. 46–110

Ng KWP, Loh PK, Sharma VK. Role of investigating thrombophilic disorders in young stroke. Stroke Res Treat. 2011 8;2011:670138. doi: 10.4061/2011/670138.

Pinto X. El tratamiento actual de la homocisteína como factor de riesgo cardiovascular. Medicina Integral, 2002;36 (5): 179-185.

Eikelboom JW, Lonn E, Genest J, Hankey G, Yusuf S. Homocysteine and cardiovascular disease: A critical review of the epidemiologic evidence. Ann Intern Med. 1999;131(5):363–75.

Zhang T, Jiang Y, Zhang S, Tie T, Cheng Y, Su X, et al. The association between homocysteine and ischemic stroke subtypes in Chinese: A meta-analysis. Med (United States). 2020;99(12).

Garcia D, Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. N Engl J Med. 2018;378(21):2010–21.

Andreoli L, Chighizola CB, Banzato A, Pons-Estel GJ, De Jesus GR, Erkan D. Estimated frequency of antiphospholipid antibodies in patients with pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis: A critical review of the literature. Arthritis Care Res. 2013;65(11):1869–73.

Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: A systematic review of the literature. Blood. 2003;101(5):1827–32.

Butler A, Neilson R. Thrombophilia Screening and Ischemic Stroke. Archives of Internal Medicine [Internet] 2004 [cited 2021 Apr 29];164(22):2502.

Austin S, Cohen H, Losseff N. Haematology and neurology. J Neurol Neurosurg Psychiatry. 2007;78(4):334–41.

Douay X, Lucas C, Caron C, Goudemand J, Leys D. Antithrombin, protein C and protein S levels in 127 consecutive young adults with ischemic stroke. Acta Neurol Scand. 1998;98(2):124–7.

Chiasakul T, De Jesus E, Tong J, Chen Y, Crowther M, Garcia D, et al. Inherited Thrombophilia and the Risk of Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019;8(19).

Tait RC, Walker ID, Perry DJ, Islam SIAM, Daly ME, McCall F, et al. Prevalence of antithrombin deficiency in the healthy population. Br J Haematol. 1994;87(1):106–12.

Keeling D, Mackie I, Moore GW, Greer IA, Greaves M. Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol. 2012;157(1):47–58.

Deepa R. J. Arachchillage. What is the appropriate anticoagulation strategy for thrombotic antiphospholipid syndrome? BJH: 2020; 1-12. https://doi.org/10.1111/bjh.16431

Montanaro, V.V., Freitas, D.D., Ruiz, M.C., Cavalcanti, E.U., Marinho, P.B., Freitas, M.C., & Oliveira, E.R. (2017). Ischemic Stroke in Young Adults: Profile of SARAH Hospital Brasília From 2008 to 2012. The Neurologist, 22, 61–63. doi: 10.1053/j.seminhematol.2007.01.008.

de Moerloose P, Boehlen F. Inherited thrombophilia in arterial disease: a selective review. Semin Hematol. 2007 Apr;44(2):106-13. doi: 10.1053/j.seminhematol.2007.01.008.

Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association council on stroke - Co-sponsored by the council on cardiovascular radiology and intervention. The American Academy of Neurology affirms the value of this guideline. Stroke. 2006; 37(2), 577–617. https://doi.org/10.1161/01.STR.0000199147.30016.74

Descargas

Publicado

2022-02-14 — Actualizado el 2022-06-30

Versiones

Cómo citar

Orozco Burbano, J. D., Urbano Albán, D. C., & Zamora Bastidas, T. Ómar. (2022). Paciente joven con accidente cerebrovascular isquémico: ¿Se debe buscar una trombofilia?. Revista Médica De Risaralda, 28(1). https://doi.org/10.22517/25395203.24715 (Original work published 14 de febrero de 2022)

Número

Sección

Artículo de revisión