- J Korean Neurol Assoc. 2003;21(4):329-333.
- Coagulopathies and Ischemic Stroke
- Dae-il Chang
- Department of Neurology, College of Medicine, Kyunghee University
- 응고이상과 허혈성 뇌졸중
- 장대일 ,
- 경희대학교 의과대학 신경과학교실
- Abstract
- "The etiology of ischemic stroke remains undetermined in nearly 40% of patients despite extensive evaluations.
Coagulopathies associated with cerebrovascular ischemia may be familial or acquired and account for 4% of all strokes.
The four important naturally occurring circulation proteins that inhibit coagulation are protein C, protein S, antithrombin
III, and heparin cofactor II. A carefully balanced interaction between these proteins and normal vascular endothelial
cells comprise a major barrier inhibiting thrombosis. The true deficiencies of these proteins are usually inherited
although many conditions such as DIC, malignancy, malnutrition, infection, and neutropenia can be associated with
acquired deficiencies. Although some data suggest an association between arterial strokes and the deficiency of these
proteins in young adults, cerebral venous thrombosis and venous infarcts gave been reported far more commonly with
deficiencies of any of these proteins. The understanding of the molecular events underlying coagulation has improved in
recent years. This has led to development of specific assays that can identify genetic abnormalities which can cause
coagulopathies. Although the technology has improved the fundamental approach to the patient has not changed. A primary
care physician requires a basic knowledge of the principles of blood coagulation so as to treat patients with simple
problems and refer patients with more unusual or complex disorders on to the specialist. The recognition that hypercoagulable
states are sometimes found in ischemic stroke patients has led to testing for these rare conditions.
Coagulopathies related to protein C, protein S, or antithrombin III deficiencies, activated protein C resistance, prothrombin
gene mutation, anticardiolipin antibodies, or lupus anticoagulant can be evaluated with various coagulation
testing strategies."
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