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The paper of Ganesan et al 1 adds the factor V Leiden mutation to the list of inherited thrombophilias which has not been shown to be significantly increased in consecutive series of children and young adults with arterial stroke.2-4 In their commentary on this paper, Brown and Bevan5 admit ignorance as to whether the finding of inherited thrombophilia in a patient with stroke indicates an increased risk of recurrent stroke but nevertheless recommend consideration of lifelong anticoagulation. No evidence in support of this recommendation is cited.
Brown and Bevan recommend repeating measurements of protein C, protein S, and antithrombin ΙΙΙ for at least 3 months after the acute event but depressed concentrations returning to normal between 12 and 24 months after childhood stroke have previously been reported.2 6 7 It would therefore seem prudent to follow concentrations of protein C and protein S for at least this time period before concluding that they can be attributed to an inherited thrombophilia, particularly if the presence of such a disorder is to be managed by “lifelong anticoagulation”.
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