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Meta-Analysis
. 2005 Apr;90(4):402-5.
doi: 10.1136/adc.2004.049163.

Thrombophilia and first arterial ischaemic stroke: a systematic review

S Haywood  1 , R Liesner, S Pindora, V Ganesan
Affiliations
Meta-Analysis

Thrombophilia and first arterial ischaemic stroke: a systematic review

S Haywood et al. Arch Dis Child. 2005 Apr.

Abstract

Aims: To undertake a systematic review of the literature reporting the prevalence of thrombophilia in children with a first arterial ischaemic stroke (AIS).

Methods: Systematic review of case-control studies reporting data for prevalence of protein C, S, and antithrombin (AT) deficiencies, activated protein C resistance (APCr), total plasma homocysteine >95th centile, the thrombophilic mutations factor V1691 GA, prothrombin 20210GA, and MTHFR C677T in children with first, radiologically confirmed, AIS.

Results: Of 1437 potentially relevant citations, 18 met inclusion criteria. A total of 3235 patients and 9019 controls had been studied. Results of meta-analyses were expressed as pooled odds ratios (OR) relating the prevalence of the thrombophilic condition in children with AIS to that in controls. The pooled OR (and 95% CI) were: protein C deficiency, 6.49 (2.96 to 14.27); protein S deficiency, 1.14 (0.34 to 3.80); AT deficiency, 1.02 (0.28 to 3.67); APCr, 1.34 (0.16 to 11.52); FV1691 GA, 1.22 (0.80 to 1.87); PT20210GA, 1.10 (0.51 to 2.34); MTHFR C677T, 1.70 (1.23 to 2.34); and total plasma homocysteine >95th centile, 1.36 (0.53 to 3.51). There was no statistical heterogeneity within these data.

Conclusions: All factors examined were more common in children with first AIS than in controls, and significantly so for protein C deficiency and the MTHFR C677T mutation. The implications of thrombophilia for prognosis and recurrence need to be established before clinical recommendations can be made regarding investigation and treatment of children with AIS.

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Figures

Figure 1
Figure 1
Forest plot showing the meta-analysis for studies comparing prevalence of protein C in children with first AIS to controls. The log OR is depicted on the horizontal axis; a positive OR indicates that protein C deficiency was more common in the patients and a negative OR indicates that it was more common in controls. Each horizontal line represents an individual study (listed on the left). The size of each filled box is proportional to the weight given to the individual study and the limits of the horizontal line represent the 95% CIs. The open diamond indicates the results of the meta-analysis, with the widest point indicating the pooled odds ratio and the horizontal limits indicating the 95% confidence intervals.
See this image and copyright information in PMC

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