Additional risk factors for in-hospital ischemic stroke. Hypercoagulation syndrome

Abstract

The risk of ischemic stroke in inpatients is higher than in the general population. This is due to both the greater comorbidity of inpatients and the presence of additional risk factors, the most studied of which are iatrogenic interventions. At the same time, the higher the probability of developing an ischemic stroke, the more risk factors the patient has. An important link in the pathogenesis of in-hospital ischemic stroke is the activation of the hemostasis system, which is an obligate consequence of a typical pathological process underlying diseases and injuries that led to hospitalization: blood loss, inflammation, mechanical tissue damage, dehydration, etc. In foreign literature, this condition is attributed to the group of acquired thrombophilia, in domestic literature the term hypercoagulation syndrome has become more widespread. Iatrogenic effects can also play an important role in the pathogenesis of hypercoagulation syndrome. It is characterized by increased readiness for thrombosis, clinical and laboratory signs of hypercoagulation, activation of various factors and components of coagulation, decreased fibrinolysis, but without the development of acute thrombosis. Hypercoagulation syndrome is rarely assessed in routine practice as a risk factor for ischemic stroke, however, it can act as an additional and main risk factor for the development of all subtypes of ischemic stroke (according to the TOAST classification), including the ESUS concept. In this regard, it is advisable to distinguish in its structure: chronic (existing before hospitalization: hereditary and/or acquired) and acute (situational, developed as a result of the underlying disease, its complications or iatrogenic effects) hypercoagulation syndromes. To designate a group of acute pathological conditions predisposing to the development of hypercoagulation syndrome, systemic and/or local thrombotic complications, including in-hospital ischemic stroke, and requiring increased preventive measures, it seems pathogenetically justified, understandable and convenient to use the term situational hypercoagulation conditions (1 table, bibliography: 19 refs)