Neurological complications of platelet disorders and disorders of coagulation

Author:

Baghshomali Sanam,Gomez, Francisco E.,Tadevosyan Aleksey,Kumar Monisha A.

Abstract

Abstract Arterial thrombosis, venous thromboembolism, and intracranial bleeding are commonly encountered in neurologically injured patients. Inherited and acquired thrombophilias and cancer-related thrombosis are common causes of ischaemic stroke, cerebral venous sinus thrombosis, and venous thromboembolism. Factor deficiencies and acquired thrombocytopenias may lead to brain haemorrhages that cause permanent disability or death. Treatment of these cerebrovascular injuries is remarkably time-sensitive and the window of opportunity to intervene is small. Treatment of arterial thrombosis, such as in myocardial infarction and stroke, differs from that of venous thromboses such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Deficiencies of natural anticoagulant proteins or gene mutations in procoagulant factors are rare; however, they are strong risk factors for venous thromboembolism (VTE), especially in the young or those with a positive family history. Inherited thrombophilias include deficiencies of the natural anticoagulant proteins antithrombin (AT), protein C (PC), and protein S (PS), as well as the gain-of-function mutations in the factor V gene (factor V Leiden (FVL)) and prothrombin gene (PT G20210A). Thrombocytopenia can be a result of impaired platelet production and bone marrow suppression, blood loss with inadequate bone marrow response, extravascular sequestration, or extracorporeal destruction (splenomegaly, dialysis), as well as intravascular consumption. For patients with acute ischaemic stroke from suspected thrombophilia, common questions relate to the choice of antithrombotic therapy, potential endovascular interventions, and the extent of diagnostic evaluation. For management of life-threatening intracranial bleeding complications, knowledge of factor replacement strategies, reversal agents, and dosing protocols are critical to achieving haemostasis and optimizing neurological outcomes. This chapter reviews neurological complications and treatment of commonly encountered coagulation disorders such as genetic haemophilias, inherited and acquired thrombocytopenias, inherited and acquired thrombophilias, and manifestations of cancer-related hypercoagulability.

Publisher

Oxford University PressOxford

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