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Ischemic Strokes in Congenital Bleeding Disorders: Comparison with Myocardial Infarction and other Acute Coronary
Antonio Girolami1, Ferrari Silvia, Cosi Elisabetta
1D.P.M.S., Dept. of Medicine, Via Ospedale 105, Padua, 35128, Italy.
Insights
Congenital bleeding disorders show varied protection against ischemic stroke and coronary artery disease, suggesting clotting defects influence atherothrombosis differently. Further research is needed to understand these mechanisms.
Area of Science:
- Hematology
- Neurology
- Cardiology
Background:
- Congenital bleeding disorders (CBDs) are associated with hemostatic abnormalities.
- The relationship between CBDs and thrombotic events like ischemic stroke is not fully understood.
- Atherothrombosis risk may be modulated by underlying clotting factor deficiencies.
Purpose of the Study:
- To investigate the incidence of ischemic stroke in patients diagnosed with congenital bleeding disorders.
- To explore potential differences in atherothrombotic risk among various types of CBDs.
Main Methods:
- A comprehensive PubMed search was conducted using relevant keywords and Medical Subject Headings.
- Patients with objectively proven ischemic stroke and CBDs were identified.
- References were cross-checked to ensure thorough data collection.
Main Results:
- The study identified cases of fibrinogen defects, Factor VII deficiency, hemophilia A and B, Factor XI deficiency, and von Willebrand Disease.
- A significant variation in the ratio of myocardial infarction to ischemic stroke was observed across different CBDs.
- Risk factors such as replacement therapy and advanced age were prevalent in the affected patients.
Conclusions:
- Clotting defects in patients with CBDs appear to confer uneven protection against atherothrombosis.
- Observed differences in ischemic stroke versus coronary arterial disease prevalence warrant further investigation.
- The underlying mechanisms responsible for these differential protective effects remain unknown and represent a key area for future research.
Objective:
To investigate the occurrence of ischemic stroke in patients with congenital bleeding disorders.
Patients And Methods:
Patients with congenital bleeding disorders who presented an objectively proven ischemic stroke were obtained by means of a time unlimited Pubmed search. Appropriate key words and Medical subject headings were used. Cross-checking of the references was also carried out.
Results:
There were four cases of Fibrinogen defects or Factor VII deficiency; seven patients had Hemophilia (6 hemophilia A and 1 hemophilia B); eight cases of FXI deficiency and six patients with von Willebrand Disease. One patient had a congenital platelet disorder. Age varied from 7 to 80 (mean age 38.6). 15 were male and 11 female. In four patients gender was not reported. The ratio of Myocardial Infarction to Ischemic stroke was 12.28 for the hemophilias, 7.83 for vW Disease and 2.75 for the Rare Bleeding Disorders. Risk factors were present in most patients, replacement therapy and old age being the most frequent.
Conclusions:
The differences in the prevalence of ischemic stroke vs coronary arterial disease seen in patient with congenital bleeding disorders indicate that clotting defects assure an uneven protection from atherothrombosis. Since the mechanisms underlying these differences are unknown, they represent a field of potential future investigation.
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