1. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2021
2223
24
25
26
27
28
29
30
-.10.1.2.3.4.5.6.7.8
IS
-.1 0 .1 .2 .3 .4
MI
PAF
Risk of myocardial infarction and ischaemic
stroke and the impact of hypercoagulability
results from the RATIO study, a nation wide case-control study
Bob Siegerink, Alberto Maino, Frits R Rosendaal, Ale Algra
Methods
All measures of hypercoagulability
investigated in the RATIO study
were compared for their effect on
MI risk and IS risk.
Given similar incidences of these
diseases, the RRs can directly be
compared.
If hypercoagulability has a similar
effect on MI risk as on IS risk, all
factors should cluster along the
blue diagonal line (figures)
b.siegerink@lumc.nl | bobsiegerink.com
1
2
34
5
6
7
8
9
10
11
12
13
14
1516
17
18
19
20
21
22
23
24
25
26
27
28
2929
30
-.50.511.522.533.54
IS
-.5 0 .5 1 1.5 2
MI
Changes in
blood flow
Hypercoagulability
Vessel wall
injury
Deep venous
thrombosis
Cardio-embolic
stroke
Arterial
thrombosis
Results and conclusions
• Hypercoagulability has a more
pronounced effect on IS risk than
MI risk
• MI and IS could have (at least
partly) different causal
mechanisms with possible
implications for treatment and
prevention
• Difference also present between
stroke subtypes?
• New research is needed to address
this difference in elderly and
males.
PAF
The population attributable
fraction is an epidemiological
measure to indicate the impact
of a risk factor on the disease
incidence in the source
population.
It represents the fraction of
disease that will be prevented
when the risk factor is removed
from the population.
RATIO study
• Nationwide case-control study
• Women with MI (N=205) or IS (N=175), <50yrs
• Cardioembolic stroke excluded
• 638 Matched controls (age/area/event year)
• Post acute phase blood collection
• 30 markers of hypercoagulability





 −
×=
OR
1OR
exposed%PAF
Rationale
Arterial thrombosis is sometimes regarded as one
disease entity with one causal mechanism. However,
thrombotic diseases have different causal
mechanisms, reflected in Virchow’s triad. It is
unknown whether the role of hypercoagulability in
the etiology of the two main forms of arterial
thrombosis, i.e. MI and IS, is similar.
PAFLog (OR)