Multiple hemostatic abnormalities in young adults with activated protein C resistance and cerebral ischemia.

BACKGROUND

The relationship between activated protein C resistance (APCR) and arterial stroke is uncertain. It has been speculated that multiple inherited or acquired prothrombotic conditions may alter the hemostatic balance towards thrombotic events.

METHODS

Case series from a University medical center.

RESULTS

In a series of 28 Caucasian patients under age 55 with cerebral ischemic events, nine were found to have activated protein C resistance. Five of nine patients (56%) had additional hematologic abnormalities. Four patients had elevated anticardiolipin IgG antibodies. Other abnormalities identified included Type I protein S deficiency, sticky platelet syndrome, and a positive lupus anticoagulant.

CONCLUSIONS

Activated protein C resistance is relatively common in young adults with cerebral ischemic events and may be accompanied by other hematologic abnormalities. The constellation of hemostatic abnormalities may impact the type of and intensity of the antithrombotic regimen. There are also implications for family members of affected patients. Finding evidence of APCR should not preclude a complete hemostatic evaluation in the young stroke patient.