TOPLINE

Mechanical risk factors for venous thrombosis (VTRFs) occurring within 14 days before stroke onset were independently associated with cryptogenic ischemic stroke (CIS) in young adults aged 18-49 years. The association was particularly strong in individuals aged 18-39 years and in those with clinically relevant patent foramen ovale (PFO).

METHODOLOGY

• Researchers conducted a multicenter case-control study including 546 patients aged 18-49 years (median age, 41 years; 47.25% women) with recent CIS and the same number of age-, sex-and ethnicity-matched stroke-free control individuals.
• CIS was defined as present if the four phenotypes‒ Atherosclerosis, Small Vessel Disease, Cardiac Source, Other Cause (A-S-C-O) classification system were graded as 0 (no disease), grade 2 (causality uncertain), or grade 3 (unlikely to be a direct cause of the stroke).
• Mechanical VTRFs — including surgical treatment, nonsurgical intervention, injury, and immobilization occurring within the acute (≤14 days) and subacute (15–90 days) prestroke intervals — were assessed using standardized, structured interviews.
• Researchers assessed the association of mechanical VTRFs with CIS, with adjustment for age, sex, level of education, and traditional and nontraditional stroke risk factors.
• Age-stratified analysis was performed for 18- to 39-year-olds and 40- to 49-year-olds, and subgroup analysis examined cases with and without clinically relevant PFO.

TAKEAWAY

• Mechanical VTRFs within 14 days prestroke were more prevalent in cases than in control individuals (15.4% vs 9.6%) and independently associated with CIS after adjustment for demographics and traditional stroke risk factors (odds ratio [OR], 1.67; P = .032).
• In age-stratified analysis, this association remained significant after additional adjustment for nontraditional risk factors in 18- to 39-year-olds (adjusted OR, 2.36; P = .046) but was not significant in the 40- to 49-year age group (fully adjusted OR, 1.50).
• Mechanical VTRFs were associated with CIS in cases with clinically relevant PFO (fully adjusted OR, 2.06; P = .008) but not in those without (OR, 1.29; P  = .344).
• No significant associations were seen for mechanical VTRFs occurring within 15-90 days before stroke; baseline levels of coagulation proteins did not differ between cases with and without mechanical VTRFs 0-14 or 15-90 days before stroke.

IN PRACTICE

"Our study highlights the clinical importance of assessing mechanical VTRFs in stroke risk evaluation for young patients, particularly in those who are younger and lack conventional RFs," the authors wrote.

SOURCE

The study was led by Julija Valančienė, MD, Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. It was published online  on August 26 in Stroke.

LIMITATIONS

The study relied on self-reported mechanical VTRFs assessed through structured interviews, which may have introduced recall bias. The analysis did not account for all potential confounders, and the observational design limited causal inference. 

DISCLOSURES

The study was supported by grants from Helsinki and Uusimaa Hospital District Research Fund, the Academy of Finland, the Sahlgrenska University Hospital, the Finnish Medical Foundation, and the Sigrid Juselius Foundation. Several authors reported receiving compensation, honoraria, research support, or other financial relationships with pharmaceutical companies and medical device manufacturers. Additional author disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.