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NEUROLOGY 2008;70:627-633
© 2008 American Academy of Neurology

Thrombophilia differences in cerebral venous sinus and lower extremity deep venous thrombosis

E. M. Wysokinska, MD, W. E. Wysokinski, MD, R. D. Brown, MD, K. Karnicki, MD, I. Gosk-Beirska, MD, D. Grill and R. D. McBane, II, MD

From the Division of Cardiovascular Medicine (E.M.W., W.E.W., R.D.M.), Division of Hematology (W.E.W., R.D.M., K.K.), Department of Neurology (R.D.B.), and Division of Biostatistics (D.G.), Mayo Clinic, Rochester, MN; and Wroclaw Medical University (E.M.W., I.G.-B.), Poland.

Address correspondence and reprint requests to Dr. Robert D. McBane II, Division of Cardiovascular Medicine, Mayo Clinic and Foundation for Education and Research, 200 S.W. First Street, Rochester, MN 55905 mcbane.robert{at}mayo.edu

Objective: To characterize differences in the prevalence of thrombophilic variables in a large cohort of patients with cerebral venous sinus thrombosis (CVST) and lower extremity deep vein thrombosis (DVT).

Methods: An inception cohort of individuals was identified with first lifetime incident CVST between 1995 and 2005 for whom comprehensive thrombophilia testing was available. To test the hypothesis that thrombophilia prevalence differs with respect to thrombus location, test results were compared to a randomly selected group of patients with lower extremity DVT with comprehensive thrombophilia testing.

Results: During this time period, 163 patients with CVST were identified who underwent comprehensive thrombophilia testing. Thrombophilia results were abnormal in 29% including anticardiolipin antibodies (17%), heterozygous factor V Leiden (10%), and heterozygous prothrombin G20210A mutation (n = 14/122; 11%). The prothrombin mutation was more than twice as common in patients with CVST (p = 0.04). Activated protein C resistance, factor V Leiden, and protein C deficiency were more common in patients with DVT (p < 0.05 for each comparison). The anticardiolipin antibodies in patients with CVST were primarily low titer IgM isotype.

Conclusion: The prevalence of selected thrombophilia factors differs comparing patients with cerebral venous sinus thrombosis and deep vein thrombosis. These differences may offer insights into mechanisms governing the geographic distribution of venous thrombosis.

Abbreviations: APC = activated protein C; CVST = cerebral venous sinus thrombosis; DVT = lower extremity deep vein thrombosis; HRT = hormone replacement therapy; OCP = oral contraceptives; VTE = venous thromboembolism.

Biostatistical support was provided by an internal grant from the Mayo Clinic Division of Cardiology.

Disclosure: The authors report no conflicts of interest.

Received April 18, 2007. Accepted in final form July 13, 2007.






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