Quelle exploration de l'hémostase dans les accidents vasculaires cérébraux ?

Abstract

The hematological causes of stroke are estimated at about 1% and are more frequent among young patients. The risk of ischemic stroke (IS) rises in polycytemia vera, essential thrombocytemia, drepanocytosis and disseminated intravascular coagulation. Functional disturbances of platelets are frequent in hemopathy and they increase hemorrhagic risk. Thrombophilias (essentially resistance to protein C, deficiency of antithrombin, protein C, Protein S, mutation of prothrombin gene) are not a significant risk factor for arterial IS. But their investigation is warranted for cerebral venous thrombosis. The resistance to protein C in children might be a risk factor for IS. The antiphospholipid antibody syndrome may rarely cause IS and should be investigated in young patients. In malignant gammapathy and leukemia, hemorrhagic strokes (HS) are more frequent because of possible thrombopenia whereas hyper-stickiness increases the risk of IS. Hyperhomocysteinemia is a minor risk factor of IS, for which vitamin substitution could be a treatment.