Pro-thrombotic States in Stroke

A large number of prothrombotic states both inherited and acquired, have been linked with ischemic cerebrovascular disease. Inherited deficiencies of the plasma coagulant inhibitory proteins, mainly protein C, protein S, antithrombin III, heparin cofactor-II, and protein Z, defects in the coagulation cascade proteins such as Factor V Leiden and prothrombin gene G20210A mutation, abnormalities of fibrinolysis and hyperhomocystinemia have been associated with stroke. Patients with disorders of the formed blood elements like polycythemia vera, sickle cell anaemia and essential thrombocythemia can also be predisposed to stroke. The most frequently identified acquired states associated with ischemic stroke are the anticardiolipin antibodies and lupus anticoagulants. Screening for occult prothrombotic diathesis is necessary for young patients with stroke of unidentifiable cause, for those with prior venous thrombosis and those with a family history of thrombosis. Knowledge in this area is still incomplete and evolving rapidly.