Do Common Prothrombotic Mutations Influence The Risk Of Cerebral Ischaemia In Patients With Patent Foramen Ovale? Systematic Review And Meta-Analysis

Conflicting results are available on the association of prothrombotic genetic abnormalities with patent foramen ovale (PFO)related cerebral ischaemia. We comprehensively sought and identified studies of the association of both the factorV Leiden (FV(G1691A) mutation) and the prothrombin mutation (PT(G20210A) mutation) with PFO-related cerebral ischaemia and did meta-analyses to assess the evidence for such a relation. We analysed data from six eligible studies in 856 cases and 1,00 1 control subjects. Additional unpublished data from a new series including 463 subjects were also entered into the analysis. The PT(G20210A) variant was significantly associated with PFO-related stroke in comparison with both control subjects (odds ratio [OR] 3.85; 95% confidence interval [CI] 2.22 to 6.66) and non-PFO-associated stroke patients (OR 2.31; 95% CI 1.20 to 4.43), whereas a trend toward an association was observed for the FV(G1691A) mutation (OR 1.18; 95% Cl 0.73 to 1.90, compared to control subjects; OR 1.14; 95% Cl 0.62 to 2.09, compared to non-PFO-associated stroke patients). The status of carrier of either the FV(G1691A) mutation or the PT(G20210A) variant was associated with a risk for stroke of 1.98 (95% Cl 1.38 to 2.83) and 1.62 (95% Cl 1.03 to 2.57), as compared to control subjects and non-PFO-associated stroke patients, respectively. Addition of common prothrombotic genetic variants to standard initial screening may contribute to stratifying PFO-associated stroke patients at different risk of ischaemic events and targeting secondary prevention strategies.