Related Experiment Videos
Coagulation disorders in young adults with acute cerebral ischaemia
A G Munts1, P J van Genderen, D W Dippel
1Department of Neurology, University Hospital Rotterdam, The Netherlands.
Insights
Idiopathic coagulation disorders are prevalent in young adults experiencing acute cerebral ischemia, affecting about a quarter of patients. These disorders are challenging to predict and may interact with other stroke risk factors.
Area of Science:
- Neurology
- Hematology
- Vascular Medicine
Background:
- Acute cerebral ischemia in young adults presents diagnostic challenges.
- Coagulation disorders are potential underlying causes of stroke in younger populations.
- Understanding the prevalence and impact of coagulation abnormalities is crucial for effective stroke management.
Purpose of the Study:
- To determine the prevalence of coagulation disorders in young adults with acute cerebral ischemia.
- To investigate the association between coagulation abnormalities and large vessel disease or cardiac embolism sources.
- To evaluate the occurrence of thrombotic events in relation to coagulation status.
Main Methods:
- Analysis of coagulation studies in 120 young adults (15-45 years) with cerebral infarction or transient ischemic attack.
- Diagnostic assessments included electrocardiography, echocardiography, duplex scanning, angiography, and specific coagulation tests (Protein S, C, antithrombin, plasminogen, anticardiolipin antibodies, lupus anticoagulant).
- Confirmed coagulation disorders were assessed for association with stroke type, vascular risk factors, large vessel disease, and recurrent thromboembolic events.
Main Results:
- Prevalence of identified coagulation abnormalities: increased immunoglobulin G anticardiolipin antibodies (ACLA) in 30 patients, lupus anticoagulant in 28, decreased protein S in 20, plasminogen in 5, protein C in 3, and antithrombin in 3.
- Confirmed coagulation disorders (persistent abnormalities) were found in a subset of these patients, particularly ACLA and lupus anticoagulant.
- Confirmed coagulation disorders were more common in patients with large vessel disease (odds ratio: 3.8) but not associated with stroke type or vascular risk factors.
- Recurrent thromboembolic events occurred in 16 patients, with no increased risk observed in those with confirmed coagulation disorders.
Conclusions:
- Idiopathic coagulation disorders are present in approximately 25% of young stroke patients.
- These disorders are difficult to predict and likely interact with other contributing risk factors for stroke.
- Further research is needed to elucidate the complex interplay between coagulation abnormalities and cerebral ischemia in young adults.
Abstract:
We analysed the results of coagulation studies in an unselected series of young adults with acute cerebral ischaemia. Our aims were (a) to determine the prevalence of coagulation disorders among these patients, (b) to investigate the relation between the presence of coagulation abnormalities and large vessel disease or potential sources of cardiac embolism and (c) to evaluate the occurrence of thrombotic events in patients with or without coagulation disorders. One hundred and twenty consecutively admitted patients (53 men, 67 women, median age 38 years, range 15-45) who presented with acute cerebral infarction (n = 89) or a transient ischaemic attack (n = 31) were evaluated. Diagnostic studies consisted of electrocardiography, echocardiography, duplex scanning, and/or angiography. Coagulation studies included activity tests of protein S, protein C, antithrombin, plasminogen, measurement of immunoglobulin G (IgG) anticardiolipin antibodies (ACLA), and a dilute prothrombin assay. Initially, 30 patients had increased ACLA titres and 28 had an abnormal dilute prothrombin assay, suggesting lupus anticoagulant. Decreased protein S, protein C and antithrombin activity were detected in 20, 3 and 3 patients, respectively, excluding patients in whom the abnormalities could be explained by the use of medication, by pregnancy or puerperium. We detected a decreased activity of plasminogen in 5 patients. The disorders could be confirmed by a second assessment in only 2 patients with a protein S deficiency, in none of the patients with a protein C or antithrombin deficiency and in 1 patient with plasminogen deficiency. However, the abnormalities persisted in 19 of 21 patients with increased anticardiolipin IgG titres and in 9 of 20 patients with lupus anticoagulant. A confirmed coagulation disorder was not associated with stroke type or vascular risk factors, but it was more common among patients with large vessel disease (odds ratio: 3.8, 95% confidence interval (CI): 1.1-12.8). Sixteen patients had a recurrent thromboembolic event, but the risk of recurrence was not increased among patients with a confirmed coagulation disorder. Our results suggest that idiopathic coagulation disorders are found in about a quarter of young stroke patients. They are difficult to predict and probably interact with other risk factors.