Association Between Recent Mechanical Risk Factors for Venous Thrombosis and Young-Onset Cryptogenic Ischemic Stroke
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: In young adults, the risk factors (RFs) for cryptogenic ischemic stroke (CIS) remain unclear. We aimed to investigate the association between recent mechanical venous thrombosis RFs (VTRFs) and young-onset CIS in this multicenter sex- and age-matched case-control study. METHODS: Five hundred forty-six patients aged 18 to 49 years (median age, 41 [34-46] years; 47.3% women) with a recent CIS and 546 stroke-free community-based controls were included in the study across 19 European centers between October 2013 and November 2022. Mechanical VTRFs, including surgical treatment, nonsurgical intervention, injury, and immobilization occurring within 90 days prestroke, were assessed using standardized, structured interviews. Conditional logistic regression was used to assess the association of mechanical VTRFs with CIS. Age, sex, level of education, and traditional and nontraditional stroke RFs were included as confounders. RESULTS: Mechanical VTRFs within 14 days prestroke were more prevalent in cases than controls (15.4% versus 9.6%) and independently associated with CIS after adjustment for demographics and traditional stroke RFs (odds ratio [OR], 1.67 [95% CI, 1.05-2.67]). In age-stratified analysis, this association remained significant after additional adjustment for nontraditional RFs in 18- to 39-year-olds (OR, 2.36 [95% CI, 1.02-5.46]) but was not significant in the 40- to 49-year age group (OR, 1.50 [95% CI, 0.73-3.08]). In addition, mechanical VTRFs were associated with CIS in cases with clinically relevant patent foramen ovale in a fully adjusted model (OR, 2.06 [95% CI, 1.21-3.51]) but not in those without (OR, 1.29 [95% CI, 0.76-2.18]). No significant associations were observed for mechanical VTRFs occurring >14 days before stroke. Baseline blood thrombophilia markers did not differ between cases with and without mechanical VTRFs 0 to 14 or 15 to 90 days before stroke. CONCLUSIONS: Recent mechanical VTRFs occurring within 14 days preceding stroke contribute to the risk of young-onset CIS, particularly in younger individuals and those with a clinically relevant patent foramen ovale. This risk does not appear to be conveyed by thrombophilic factors assessed. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01934725.
Source: Stroke
Authors: Julija Valančienė, Pauli Ylikotila, Riikka Lautamäki, Marialuisa Zedde, Teresa Grimaldi, Tomi Sarkanen, Essi Ryödi, Dalius Jatužis, Kristina Ryliškienė, Diana Zakarkaitė, Bettina von Sarnowski, Raila Busch, Lauri Tulkki, Jani Pirinen, Nicolas Martinez-Majander, Radim Licenik, Phillip Ferdinand, Cheryl Oxley, Janika Kõrv, Piibe Muda, Tuukka A. Helin, Lotta Joutsi-Korhonen, Tímea Szántó, Alessandro Pezzini, Carlo Mario Lombardi, Georgios Tsivgoulis, Satu Suihko, Heli Tolppanen, Ana Catarina Fonseca, Patricia Martínez-Sánchez, Laura Amaya-Pascasio, Sofie Abels, Frank-Erik de Leeuw, Nilufer Yesilot, Mine Sezgin, Ulrike Waje-Andreassen, Sahrai Saeed, Petra Redfors, Odd Bech-Hanssen, Juha Huhtakangas, Marja Hedman, Pekka Jäkälä, Hugo ten Cate, Eva Gerdts, Mika Lehto, Juha Sinisalo, Jukka Putaala, Külliki Karu, Janika Kõrv, Liisa Kõrv, Piibe Muda, Riina Vibo, Shakar Kutal, Mika Lehto, Nicolas Martinez-Majander, Jani Pirinen, Jukka Putaala, Janne Rapola, Tiina Sairanen, Maximillian Sihvo, Juha Sinisalo, Lauri Soinne, Satu Suihko, Marjaana Tiainen, Heli Tolppanen, Liisa Tomppo, Lauri Tulkki, Suvi Tuohinen, Jaana Autere, Marja Hedman, Nina Jaakonmäki, Pekka Jäkälä, Tuuli Miettinen, Ossi Nerg, Heikki Numminen, Essi Ryödi, Tomi Sarkanen, Marko Virtanen, Riitta Lautamäki, Antti Saraste, Pauli Ylikotila, Ulla Junttola, Laura Kytövuori, Raila Busch, Ulf Schminke, Bettina von Sarnowski, Marco Ritelli, Aleksandra Ekkert, Dalius Jatuzis, Rytis Masiliunas, Kristina Ryliskiene, Julija Valančienė, Diana Zakarkaite, Frank-Erik de Leeuw, Merel Ekker, Suzette Elias-Smale, Myrna M.E. van Dongen, Annette Fromm, Eva Gerdts, Sahrai Saeed, Ulrike Waje-Andreassen, André Paula, Patricia Martínez-Sánchez, Victoria Mejias Olmedo, Laura Amaya Pascasio, Raul Reyes Parrilla, Elvira Carrión Rios, Margareta Abrahamson, Odd Bech-Hanssen, Maria Davidson, Lukas Holmegaard, Mikael Jerndal, Katarina Jood, Annika Nordanstig, Petra Redfors, Turgut Tatlisumak, Esme Ekizoglu Turgut, Sezgin Mine, Nilufer Yesilot, Cheryl Oxley, Zoltan Pencz, Christine Roffe, Mohammad Hacque, Muhammad Khaled Hasan, Radim Licenik, Peter Owusu-Agyei, Santhosh Subramonian
Institutions: University of Helsinki, Vilnius University, Helsinki University Hospital, University of Turku, Turku University Hospital, Azienda Sanitaria Unità Locale di Reggio Emilia, Tampere University, Tampere University Hospital, University of Tampere, Universitätsmedizin Greifswald, Universität Greifswald, Peterborough City Hospital, University Hospitals of North Midlands NHS Trust, University of Tartu, Hospital District of Helsinki and Uusimaa, University of Parma, Ospedale di Parma, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, National and Kapodistrian University of Athens, University General Hospital Attikon, University of Lisbon, Hospital de Santa Maria, Complejo Hospitalario Torrecárdenas, University of Almería, Radboud University Nijmegen, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Istanbul University, Haukeland University Hospital, Sahlgrenska University Hospital, University of Gothenburg, Oulu University Hospital, University of Oulu, Kuopio University Hospital, University of Eastern Finland, Maastricht University Medical Centre, Maastricht University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funders: Itä-Suomen Yliopisto, Helsingin Yliopisto, Suomen Lääketieteen Säätiö, Kuopion Yliopistollinen Sairaala, Maastricht Universitair Medisch Centrum, Università degli Studi di Parma, Universitetet i Bergen, National and Kapodistrian University of Athens, Sahlgrenska Universitetssjukhuset, Göteborgs Universitet, Universidade de Lisboa, Oulun Yliopisto, Radboud Universitair Medisch Centrum, Università degli Studi di Brescia, Tartu Ülikool, Haukeland Universitetssjukehus, Tays, Turun Yliopistollinen Keskussairaala, Universidad de Almería, Sahlgrenska Akademin, CARIM School for Cardiovascular Diseases, Universiteit Maastricht, Faculty of Medicine and Health, University of Sydney
OpenAlex ID: W7204269359