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hypercoagulable states and stroke

Lucy C Thomas, Lesley Ann Hall, John R Attia, Elizabeth G Holliday, Hugh S Markus, Christopher R Levi
BACKGROUND: Cervical artery dissection (CAD) is a leading cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of seasonal variation in CAD incidence have been suggested but may reflect extreme climatic conditions. Seasonal variation may implicate more transient seasonal causes such as proinflammatory or hypercoagulable states. This study aimed to assess whether CAD incidence varied with season between UK and Australian sites. Also, this study aimed to determine whether there was a different pattern of seasonal variation between arteries (carotid and vertebral) and any association between CAD incidence and clinical factors...
October 10, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Alex Gonzalez-Bossolo, Alexis Gonzalez-Rivera, Santiago Coste-Sibilia
Thyroid storm is a life-threatening condition that occurs secondary to an uncontrolled hyperthyroid state. Atrial fibrillation is a cardiovascular complication occurring in up to 15% of patients experiencing thyroid storm, and if left untreated this condition could have up to a 25% mortality rate. Thyroid storm with stroke is a rare presentation. This case report details a left middle cerebral artery (MCA) stroke with global aphasia and thyroid storm in a 53-year-old Hispanic male patient. Although uncommon, this combination has been reported in multiple case series...
2016: Case Reports in Endocrinology
John P O'Laughlin, Gautam Verma, Iosif Gulkarov
We present a case of a young female with stroke symptoms who underwent valve sparing resection of a presumed fibroelastoma based on echocardiographic findings. After confirming embolic stroke, she underwent excision of the lesion, which on pathology revealed a nonbacterial thrombus. Ultimately, this led to a more extensive work-up leading to the discovery of a papillary serous ovarian carcinoma, the underlying cause of her hypercoagulable state. The initial echocardiographic findings painted the clear picture of a papillary tumor on the aortic valve which was likely the source of the emboli resulting in ischemic stroke...
2016: Case Reports in Cardiology
Ozan Kocak, Coskun Yarar, Ayşe Bozkurt Turhan, Olga Meltem Akay, Kursat Bora Carman, Ayten Yakut
BACKGROUND: Perinatal arterial ischemic stroke (PAIS) is an important cause of pediatric morbidity and mortality. The etiology of PAIS remains unknown. Several maternal-neonatal disorders, and especially prothrombotic risk factors, have been reported in infants with perinatal stroke (PS). Rotation thromboelastometry (ROTEM) can analyze the coagulation system, from the beginning of coagulation, through clot formation, and ending with fibrinolysis. The aim of this study was to evaluate the hypercoagulability state in PAIS patients using ROTEM...
August 11, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Ahsan Mukhtar, Sidra Malik, Muhammad Saim Khan, Mazhar Ishaq
Retinal artery occlusion is an uncommon condition but can lead to grave consequences if not managed in time. Elderly population with other comorbid conditions like hypertension, ischemic heart disease, hyperlipidemia and stroke are commonly affected. However, this condition may affect younger population with entirely different systemic associations. Thromboembolism, which usually takes place secondary to cardiac emboli or hypercoagulable states cause retinal artery occlusion in young population. A24-year lady presented with a short history of unilateral altitudinal visual loss...
July 2016: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Kunitaka Maruyama, Naoki Akioka, Daina Kashiwazaki, Naoya Kuwayama, Satoshi Kuroda
The authors describe herein the first adult case with moyamoya disease associated with protein Z deficiency. A 41-year-old woman was admitted to our hospital due to sudden onset of dysarthria and left extremity weakness 6 days after the delivery of her first baby. Previously, she repeated early fetal losses and was diagnosed with protein Z deficiency. Laboratory examination showed that the plasma concentration of protein Z was .73 µg/ml, being lower than the control. Radiological examination demonstrated typical findings of moyamoya disease with advanced stage on both sides...
September 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Rafal Meus, Maksim Son, Dorota Sobczyk, Anetta Undas
BACKGROUND AND PURPOSE: We hypothesized that formation of left atrial appendage (LAA) thrombi of unknown origin is associated with altered fibrin clot properties and blood hypercoagulability. METHODS: In a case-control study, we investigated 32 patients with a history of LAA thrombus after successful anticoagulant treatment versus 32 control subjects matched for age, sex, and diabetes mellitus. All subjects had previous ischemic stroke, transient ischemic attack, or migraine associated with patent foramen ovale...
July 2016: Stroke; a Journal of Cerebral Circulation
Tae-Won Kim, In-Uk Song, Sung-Woo Chung, Joong-Seok Kim, Jaseong Koo, Kwang-Soo Lee
Objective Left atrial enlargement (LAE) may predispose individuals to blood stasis in atrial fibrillation (AF), and thus play a crucial role in thrombogenesis. The D-dimer level is one of the surrogate markers for a hypercoagulable state and reflects thrombus formation in AF. Since the D-dimer level reflects hypercoagulability as well as thrombus and fibrin burdens, LAE could be associated with a D-dimer elevation. However, no studies have explored this association or which factors contribute to increases in the D-dimer levels in patients with AF...
2016: Internal Medicine
Jennifer A Sumner, Laura D Kubzansky, Christopher Kabrhel, Andrea L Roberts, Qixuan Chen, Ashley Winning, Paola Gilsanz, Eric B Rimm, Maria M Glymour, Karestan C Koenen
BACKGROUND: Trauma exposure and posttraumatic stress disorder (PTSD) have been linked to myocardial infarction and stroke in women, with biological and behavioral mechanisms implicated in underlying risk. The third most common cardiovascular illness, venous thromboembolism (VTE), is a specific health risk for women. Given previous associations with other cardiovascular diseases, we hypothesized that high levels of trauma and PTSD symptoms would be associated with higher risk of incident VTE in younger and middle-aged women...
May 2016: Journal of the American Heart Association
Megan L Garcia, Katharine Caldwell, Anna Kellund, Cynthia Reyes
We report a case of middle cerebral artery stroke with heterozygosity for 2 separate hypercoagulable conditions following repair of an H-type tracheoesophageal fistula (TEF) in an infant. Neonatal stroke is rare, occurring in 1 in 4000 births annually in the United States. Stroke after pediatric surgery occurs in approximately 0.05% of patients. Etiologies of stroke in neonates include cardiac, hematologic, vascular, traumatic, metabolic, pharmacologic, infectious, and hypoxemic insults. Thrombophilia has been described in 42% to 78% of neonates with neonatal stroke...
October 2016: Journal of Pediatric Hematology/oncology
Akhil Narang, Roberto M Lang
Despite advances in the treatment of patients with heart failure, mortality is still substantial. Part of this mortality is explained by cardioembolic stroke. Patients with heart failure are predisposed to developing cardioembolic strokes owing to abnormalities in Virchow's triad (endothelial function, relative hypercoagulable state, and static blood flow). Several randomized controlled trials have addressed whether patients with heart failure benefit from anticoagulation. Overall, the results suggest the risk of bleeding with anticoagulation outweighs any small benefit conferred by anticoagulation...
May 2016: Cardiology Clinics
Darrin J Lee, Arjang Ahmadpour, Tamar Binyamin, Brian C Dahlin, Kiarash Shahlaie, Ben Waldau
Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke with a variable presentation, ranging from headaches, to coma and death. Although the American Stroke Association has developed guidelines for the treatment of CVST, data are sparse on the outcome after treatment with anticoagulation, thrombolysis, and thrombectomy. In this retrospective review, we describe the 5-year UC Davis experience with spontaneous CVST. Forty-one patients (mean age 37.5±23.1, range 0-96 years; 29 female) were identified with CVST...
April 19, 2016: Journal of Neurointerventional Surgery
Oliver Königsbrügge, Silvia Koder, Julia Riedl, Simon Panzer, Ingrid Pabinger, Cihan Ay
The thrombin generation potential is an in vitro measure for the capacity of an individual to generate thrombin and recognized as a reflection of a hypo- or hypercoagulable status. Measurement of the in vivo thrombin activity, however, may be of clinical significance. We evaluated a new assay for in vivo thrombin activity and compared it to the in vitro thrombin generation potential in patients with hemophilia A (N = 15), oral anticoagulation for atrial fibrillation (AF) (N = 20), subjects with active cancer (N = 21), and healthy volunteers (N = 10)...
April 19, 2016: Clinical and Experimental Medicine
Yoshio Uetsuka
Atrial fibrillation (AF) is said to be a pre-thrombotic state. In patients with AF, the left atrium is usually dilated and blood flow is sluggish, which enables the formation of a thrombus within the left atrium. This is consistent with two of Virchow's Triad, stasis of blood flow and endothelial injury, but the last of the Triad, hypercoagulability of blood, is difficult to explain in AF. There are reports that von Willebrand Factor (vWF), FVIII, fibrinogen, D-dimer, and Fragment 1+2 are elevated in AF patients...
December 2015: Rinsho Byori. the Japanese Journal of Clinical Pathology
Yasufumi Gon, Shuhei Okazaki, Yasukazu Terasaki, Tsutomu Sasaki, Toshiki Yoshimine, Manabu Sakaguchi, Hideki Mochizuki
OBJECTIVE: To clarify the characteristics of cryptogenic stroke in patients with active cancer. METHODS: Patients with or without cancer diagnosed with acute ischemic stroke between January 2006 and February 2015 were extracted from a prospectively collected stroke database of Osaka University Hospital. Patients were categorized according to the presence of active cancer and known stroke mechanisms. RESULTS: Among 1191 patients with acute ischemic stroke, 145 (12%) had active cancer...
April 2016: Annals of Clinical and Translational Neurology
Henri M H Spronk, Anne Margreet De Jong, Sander Verheule, Hetty C De Boer, Alexander H Maass, Dennis H Lau, Michiel Rienstra, Arne van Hunnik, Marion Kuiper, Stijn Lumeij, Stef Zeemering, Dominik Linz, Pieter Willem Kamphuisen, Hugo Ten Cate, Harry J Crijns, Isabelle C Van Gelder, Anton Jan van Zonneveld, Ulrich Schotten
AIMS: Atrial fibrillation (AF) produces a hypercoagulable state. Stimulation of protease-activated receptors by coagulation factors provokes pro-fibrotic, pro-hypertrophic, and pro-inflammatory responses in a variety of tissues. We studied the effects of thrombin on atrial fibroblasts and tested the hypothesis that hypercoagulability contributes to the development of a substrate for AF. METHODS AND RESULTS: In isolated rat atrial fibroblasts, thrombin enhanced the phosphorylation of the pro-fibrotic signalling molecules Akt and Erk and increased the expression of transforming growth factor β1 (2...
April 12, 2016: European Heart Journal
Charlotte Thålin, Melanie Demers, Bo Blomgren, Siu Ling Wong, Magnus von Arbin, Anders von Heijne, Ann Charlotte Laska, Håkan Wallén, Denisa D Wagner, Sara Aspberg
INTRODUCTION: Large elevations of high sensitive Troponin T (hsTnT) in ischemic stroke patients is associated with a poor outcome. In a pilot study we found a high prevalence of malignancies among these patients. Since neutrophil extracellular traps (NETs) have been linked to cancer-associated thrombosis, we hypothesized that the concomitant cerebral and myocardial ischemia could be the result of a NET-induced hypercoagulable state. MATERIALS AND METHODS: Clinical assessments, plasma analyses and autopsies with histopathology (in cases of in-hospital mortality) were performed on ischemic stroke patients with high elevations of hsTnT (N=12) and normal hsTnT (N=19)...
March 2016: Thrombosis Research
Ryuhei Kono, Hirotaka Iwaki, Shinichi Takeshima, Yutaka Shimoe, Shinzo Ota, Masaru Kuriyama
Of the 11,161 cases of stroke observed for over 9 years, 21 cases in which both levels of serum albumin and cholesterol were < 3 g/dl and > 250 mg/dl, respectively, were identified. Out of these 21 cases, cases of severe proteinuria, i.e., nephrotic syndrome were selected. These included 10 cases of arterial ischemic thrombosis, 2 cases of cerebral venous sinus thrombosis, and 4 cases of intracerebral hemorrhage. The incidence of intracerebral hemorrhage associated with nephrotic syndrome was 0...
2016: Rinshō Shinkeigaku, Clinical Neurology
Paulino Alvarez, Andrea M Cordero-Reyes, Cesar Uribe, Patricio De Hoyos, Donna Martinez, Arvind Bhimaraj, Barry H Trachtenberg, Guha Ashrith, Guillermo Torre-Amione, Mathias Loebe, Javier Amione-Guerra, Lawrence Rice, Jerry D Estep
BACKGROUND: Thrombotic events in patients with continuous flow left ventricular assist devices (CF-LVADs) are associated with significant morbidity and mortality. The objective of this study was to delineate the frequency, clinical characteristics, and outcomes of patients with hypercoagulable states who undergo CF-LVAD implantation. METHODS: We performed a retrospective review of 168 consecutive patients who underwent CF-LVAD implantation between 2010 and 2013...
July 2016: Journal of Cardiac Failure
Janette Bester, Mia-Jeanne van Rooy, Sthembile Mbotwe, Wiebren Duim, Etheresia Pretorius
Transient ischemic attack (TIA) is an important predictor of future ischemic events, including stroke. Due to the typically brief period of neurologic dysfunction, patients often overlook the importance of reporting a TIA. We have recently shown that platelet activation plays an important role in TIA pathology. In a similar vein, smoking is associated with a hypercoagulable state and is also one of the important risk factors for stroke. Here we present an interesting case where a 61-year-old male, with hypercholesterolemia, and a previous heart valve replacement, developed a TIA 5 months after he started smoking...
2016: Ultrastructural Pathology
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