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Acute ischemic stroke in myeloproliferative neoplasia: Using molecular pathophysiology knowledge to treat prothrombotic state with direct oral anticoagulants
Author(s) -
Hollen Christopher W,
Shujaat Syeda D,
Ray Bappaditya
Publication year - 2019
Publication title -
neurology and clinical neuroscience
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.125
0ISSN - 2049-4173
DOI - 10.1111/ncn3.12248
Subject(s) - medicine , essential thrombocythemia , thrombus , stroke (engine) , polycythemia vera , thrombosis , defibrotide , basilar artery , pathophysiology , ischemic stroke , cardiology , ischemia , disease , hematopoietic stem cell transplantation , mechanical engineering , engineering
Myeloproliferative neoplasms ( MPN ) are defined by clonal expansion of hematopoietic progenitor cells and often associated with systemic thrombosis. Arterial thrombi due to MPN have a multifactorial etiology and are typically managed with antiplatelet agents. However, recent mechanistic studies on patients with JAK 2V617F mutations have demonstrated alterations in cellular heparanase activity that results in a hypercoagulable state. We report a patient with MPN presenting with acute ischemic stroke caused by a basilar artery thrombus due to JAK 2V617F mutation related hypercoagulability. Newer direct oral anticoagulants may be appropriate for secondary stroke prevention in such cases.