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Increased Platelet Aggregability in Young Patients With Stroke: Diagnosis and Therapy

Increased Platelet Aggregability in Young Patients With Stroke: Diagnosis and Therapy Abstract Four patients ages 20 to 38 years had repeated cerebrovascular occlusions. Three of the four patients had vascular headaches (classical migraine in two) for some years before their first occlusive event occurred. When first seen at the time of their major cerebrovascular occlusion, all had evidence of plasma hypercoagulability, and two of the women were receiving birth control pills. Many months later, while off the "pill" and on warfarin sodium (Coumadin) therapy, two women and one man continued to have new cerebrovascular symptoms. For the first time, their platelet aggregability was tested to several biological substances known to come in contact with platelets in vivo. At this time, all four patients were found to have platelet hyperaggregability. The three symptomatic patients also had a shortened platelet survival time. Long-term management of these patients with chronic platelet aggregability and chronic plasma hypercoagulability is described. References 1. Louis S, McDowell F: Stroke in young adults . Ann Intern Med 66:932-938, 1967.Crossref 2. DeVivo DC, Farrell FW: Vertebrobasilar occlusive disease in children: A recognizable clinical entity . Arch Neurol 26:278-281, 1972.Crossref 3. Okawara SH, Calkins RA: Cerebral arterial occlusive disease with telangiectasia associated with oral contraceptives . Arch Neurol 29:60-62, 1973.Crossref 4. Masi AT, Dugdale M: Cerebrovascular disease associated with the use of oral contraceptives: A review of English literature . Ann Intern Med 72:111-121, 1970.Crossref 5. Bingel AS, Binott PS: Oral contraceptives: Therapeutics versus adverse reactions with an outlook for the future . J Pharm Sci 62:179-200, 349-362, 1973.Crossref 6. Collaborative group for the study of stroke in young women: Oral contraception and increased risk of cerebral ischemia or thrombosis . N Engl J Med 288:871-878, 1973.Crossref 7. Hovig T: The role of platelets in thrombosis . Throm Diath Haemorrh 42:137-153, 1970. 8. Bladin PF: A radiologic and pathologic study of embolism of the internal carotid-middle cerebral arterial axis . Radiology 82:615-625, 1964.Crossref 9. Whitty CWM: Migraine without headache . Lancet 2:283-285, 1967.Crossref 10. Swank RL, Davis E: Blood cell aggregation and screen filtration pressure . Circulation 33:617-624, 1966.Crossref 11. Dhall DP, Engeset J, McKenzie FN, et al: Screen filtration pressure of blood: An evaluation . Cardiovasc Res 3:147-154, 1969.Crossref 12. Swank RL: The screen filtration pressure method in platelet research: Significance and interpretation . Ser Haematol 1:146-167, 1968. 13. Eika C: Platelet refractory state induced by heparin . Scand J Haematol 9:665-672, 1972.Crossref 14. Praga CA, Pogliani EM: Effect of temperature on ADP-induced platelet aggregation: Its significance in studying antiaggregating drugs . Thromb Diath Haemorrh 29:183-189, 1973. 15. von Kaulla E, von Kaulla KN, Droegemueller W: Clinical hypercoagulability and oral contraceptives . Rocky Mt Med J 69:33-36, 1971. 16. Aster RH, Jandl JH: Platelet sequestration in man: I. Methods . J Clin Invest 43:843-855, 1964.Crossref 17. Steele PP, Weily HS, Genton E: Platelet survival and adhesiveness in recurrent venous thrombosis . N Engl J Med 288:1148-1152, 1973.Crossref 18. Connor RCR: Complicated migraine: A study of permanent neurological and visual defects caused by migraine . Lancet 2:1072-1075, 1962.Crossref 19. von Kaulla KN, von Kaulla E: Thrombin generation in normal subjects and cardiac patients . Circ Res 14:436-446, 1964.Crossref 20. von Kaulla E, Droegemueller W, Aoki N, et al: Antithrombin III depression and thrombin generation acceleration in women taking oral contraceptives . Am J Obstet Gynecol 109:868-873, 1971. 21. von Kaulla E, von Kaulla KN: Antithrombin III and diseases . Am J Clin Pathol 48:69-80, 1967. 22. Mustard JF: Prevention of platelet thrombi , in Caen J (ed): Platelet Aggregation . Paris, Massoncie, 1971. 23. Packham MA, Warrior ES, Glynn MF, et al: Alteration of the response of platelets to surface stimuli by pyrazole compounds . J Exp Med 126:171-188, 1967.Crossref 24. Evans G: Effect of platelet-suppressive agents on the incidence of amaurosis fugax and transient cerebral ischemia, McDowell FH, Brennan RW (eds): Cerebral Vascular Disease: Eighth Conference. New York, Grune & Stratton, 1973. 25. Burns JJ, Rose RK, Chenkin T, et al: The physiological deposition of phenylbutazone (Butazolidin) in man and a method for its estimation in biological material . J Pharmacol Exp Ther 109:346-357, 1953. 26. Zucker MB, Peterson J: Effect of acetylsalicylic acid, other nonsteroidal anti-inflammatory agents and dipyridamole on human blood platelets . J Lab Clin Med 76:66-75, 1970. 27. Dyken ML, Kolar OJ, Jones FH: Differences in the occurrence of carotid transient ischemic attacks associated with antiplatelets aggregation therapy . Stroke 4:732-736, 1973.Crossref 28. Fields WS, Hass WK (eds): Aspirin, Platelets and Stroke . St. Louis, WH Green Inc, 1970. 29. Mundall J, Quintero P, von Kaulla KN, et al: Transient monocular blindness and increased platelet aggregability treated with aspirin: A case report . Neurology 22:280-285, 1972.Crossref 30. Giacovazzo M: The pathophysiological basis of modern treatment of migraine headache . Res Clin Stud Headache 3:321-324, 1972. 31. Cotton RC, Bloor K, Archibald G: The effect of pyridinolcarbamate on the platelet response to ADP in patients with intermittent claudication , in Shimamoto T, Numano F, Addison GM (eds): Atherogenesis II . Princeton, NJ, Excerpta Medica Foundation, 1973. 32. Goto Y, Nakamura H: Effect of pyridinolcarbamate on plasma lipids and glucose in vivo , Shimamoto T, Numano F (eds): Atherogenesis I . Princeton, NJ, Excerpta Medica Foundation, 1969. 33. Hockaday JM, Williamson DH, Whitty CWM: Blood-glucose levels and fatty-acid metabolism in migraine related to fasting . Lancet 1:1153-1156, 1971.Crossref 34. Bolton CH, Hampton JR, Mitchell JRA: Effect of oral contraceptive agents on platelets and plasma phospholipids . Lancet 1:1336-1341, 1968.Crossref 35. Lunell NO, Persson B, Ohqvist G: The effect of an oral combined contraceptive on plasma levels of glucose, free fatty acids, glycerol, D-β hydroxybutyrate and triglycerides . Acta Obstet Gynecol Scand 52:23-24, 1973.Crossref 36. Irey NS, Manion WC, Taylor HB: Vascular lesions in women taking oral contraceptives . Arch Pathol 89:1-8, 1970. 37. Karpatkin S: Heterogeneity of human platelets: II. Functional evidence suggestive of young and old platelets . J Clin Invest 48:1083-1087, 1969.Crossref 38. Sicuteri F, Del Bianco PL, Anselmi B: Migraine as a cyclic disease with latent and overt components: Effect with antaminic drugs . Headache 10:53-62, 1970.Crossref 39. Curzon G, Barrie M, Wilkinson MIP: Relationship between headache and amine changes after administration of reserpine to migrainous patients . J Neurol Neurosurg Psychiatr 32:555-561, 1969.Crossref 40. Hilton BP, Cumings JN: 5-hydroxytryptamine levels and platelet aggregation responses in subjects with acute migraine headache . J Neurol Neurosurg Psychiatr 35:505-509, 1972.Crossref 41. Sicuteri F, Buffoni F, Anselmi B, et al: An enzyme (MAO) defect on the platelets in migraine . Res Clin Stud Headache 3:245-251, 1972. 42. Moolten SE, Jennings PB, Solden A: Dietary fat and platelet adhesiveness in atherosclerosis and diabetes . Am J Cardiol 11:290-300, 1963.Crossref 43. Bennet PN: Effect of physical exercise on platelet adhesiveness . Scand J Haematol 9:138-141, 1972.Crossref 44. Packham MA, Mustard JF: Platelet reactions . Semin Hematol 8:30-64, 1971. 45. von Kaulla E, Droegemueller W, von Kaulla KN: Effect of estrogens on postpartum hypercoagulability and antithrombin III activity . Am J Obstet Gynecol 113:920-926, 1972. 46. Williams JW, Beutler E, Erslev AJ, et al (eds): Haematology . New York, McGraw-Hill Book Co Inc, 1972. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Increased Platelet Aggregability in Young Patients With Stroke: Diagnosis and Therapy

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1975.00490430035004
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Abstract

Abstract Four patients ages 20 to 38 years had repeated cerebrovascular occlusions. Three of the four patients had vascular headaches (classical migraine in two) for some years before their first occlusive event occurred. When first seen at the time of their major cerebrovascular occlusion, all had evidence of plasma hypercoagulability, and two of the women were receiving birth control pills. Many months later, while off the "pill" and on warfarin sodium (Coumadin) therapy, two women and one man continued to have new cerebrovascular symptoms. For the first time, their platelet aggregability was tested to several biological substances known to come in contact with platelets in vivo. At this time, all four patients were found to have platelet hyperaggregability. The three symptomatic patients also had a shortened platelet survival time. Long-term management of these patients with chronic platelet aggregability and chronic plasma hypercoagulability is described. References 1. Louis S, McDowell F: Stroke in young adults . Ann Intern Med 66:932-938, 1967.Crossref 2. DeVivo DC, Farrell FW: Vertebrobasilar occlusive disease in children: A recognizable clinical entity . Arch Neurol 26:278-281, 1972.Crossref 3. Okawara SH, Calkins RA: Cerebral arterial occlusive disease with telangiectasia associated with oral contraceptives . Arch Neurol 29:60-62, 1973.Crossref 4. Masi AT, Dugdale M: Cerebrovascular disease associated with the use of oral contraceptives: A review of English literature . Ann Intern Med 72:111-121, 1970.Crossref 5. Bingel AS, Binott PS: Oral contraceptives: Therapeutics versus adverse reactions with an outlook for the future . J Pharm Sci 62:179-200, 349-362, 1973.Crossref 6. Collaborative group for the study of stroke in young women: Oral contraception and increased risk of cerebral ischemia or thrombosis . N Engl J Med 288:871-878, 1973.Crossref 7. Hovig T: The role of platelets in thrombosis . Throm Diath Haemorrh 42:137-153, 1970. 8. Bladin PF: A radiologic and pathologic study of embolism of the internal carotid-middle cerebral arterial axis . Radiology 82:615-625, 1964.Crossref 9. Whitty CWM: Migraine without headache . Lancet 2:283-285, 1967.Crossref 10. Swank RL, Davis E: Blood cell aggregation and screen filtration pressure . Circulation 33:617-624, 1966.Crossref 11. Dhall DP, Engeset J, McKenzie FN, et al: Screen filtration pressure of blood: An evaluation . Cardiovasc Res 3:147-154, 1969.Crossref 12. Swank RL: The screen filtration pressure method in platelet research: Significance and interpretation . Ser Haematol 1:146-167, 1968. 13. Eika C: Platelet refractory state induced by heparin . Scand J Haematol 9:665-672, 1972.Crossref 14. Praga CA, Pogliani EM: Effect of temperature on ADP-induced platelet aggregation: Its significance in studying antiaggregating drugs . Thromb Diath Haemorrh 29:183-189, 1973. 15. von Kaulla E, von Kaulla KN, Droegemueller W: Clinical hypercoagulability and oral contraceptives . Rocky Mt Med J 69:33-36, 1971. 16. Aster RH, Jandl JH: Platelet sequestration in man: I. Methods . J Clin Invest 43:843-855, 1964.Crossref 17. Steele PP, Weily HS, Genton E: Platelet survival and adhesiveness in recurrent venous thrombosis . N Engl J Med 288:1148-1152, 1973.Crossref 18. Connor RCR: Complicated migraine: A study of permanent neurological and visual defects caused by migraine . Lancet 2:1072-1075, 1962.Crossref 19. von Kaulla KN, von Kaulla E: Thrombin generation in normal subjects and cardiac patients . Circ Res 14:436-446, 1964.Crossref 20. von Kaulla E, Droegemueller W, Aoki N, et al: Antithrombin III depression and thrombin generation acceleration in women taking oral contraceptives . Am J Obstet Gynecol 109:868-873, 1971. 21. von Kaulla E, von Kaulla KN: Antithrombin III and diseases . Am J Clin Pathol 48:69-80, 1967. 22. Mustard JF: Prevention of platelet thrombi , in Caen J (ed): Platelet Aggregation . Paris, Massoncie, 1971. 23. Packham MA, Warrior ES, Glynn MF, et al: Alteration of the response of platelets to surface stimuli by pyrazole compounds . J Exp Med 126:171-188, 1967.Crossref 24. Evans G: Effect of platelet-suppressive agents on the incidence of amaurosis fugax and transient cerebral ischemia, McDowell FH, Brennan RW (eds): Cerebral Vascular Disease: Eighth Conference. New York, Grune & Stratton, 1973. 25. Burns JJ, Rose RK, Chenkin T, et al: The physiological deposition of phenylbutazone (Butazolidin) in man and a method for its estimation in biological material . J Pharmacol Exp Ther 109:346-357, 1953. 26. Zucker MB, Peterson J: Effect of acetylsalicylic acid, other nonsteroidal anti-inflammatory agents and dipyridamole on human blood platelets . J Lab Clin Med 76:66-75, 1970. 27. Dyken ML, Kolar OJ, Jones FH: Differences in the occurrence of carotid transient ischemic attacks associated with antiplatelets aggregation therapy . Stroke 4:732-736, 1973.Crossref 28. Fields WS, Hass WK (eds): Aspirin, Platelets and Stroke . St. Louis, WH Green Inc, 1970. 29. Mundall J, Quintero P, von Kaulla KN, et al: Transient monocular blindness and increased platelet aggregability treated with aspirin: A case report . Neurology 22:280-285, 1972.Crossref 30. Giacovazzo M: The pathophysiological basis of modern treatment of migraine headache . Res Clin Stud Headache 3:321-324, 1972. 31. Cotton RC, Bloor K, Archibald G: The effect of pyridinolcarbamate on the platelet response to ADP in patients with intermittent claudication , in Shimamoto T, Numano F, Addison GM (eds): Atherogenesis II . Princeton, NJ, Excerpta Medica Foundation, 1973. 32. Goto Y, Nakamura H: Effect of pyridinolcarbamate on plasma lipids and glucose in vivo , Shimamoto T, Numano F (eds): Atherogenesis I . Princeton, NJ, Excerpta Medica Foundation, 1969. 33. Hockaday JM, Williamson DH, Whitty CWM: Blood-glucose levels and fatty-acid metabolism in migraine related to fasting . Lancet 1:1153-1156, 1971.Crossref 34. Bolton CH, Hampton JR, Mitchell JRA: Effect of oral contraceptive agents on platelets and plasma phospholipids . Lancet 1:1336-1341, 1968.Crossref 35. Lunell NO, Persson B, Ohqvist G: The effect of an oral combined contraceptive on plasma levels of glucose, free fatty acids, glycerol, D-β hydroxybutyrate and triglycerides . Acta Obstet Gynecol Scand 52:23-24, 1973.Crossref 36. Irey NS, Manion WC, Taylor HB: Vascular lesions in women taking oral contraceptives . Arch Pathol 89:1-8, 1970. 37. Karpatkin S: Heterogeneity of human platelets: II. Functional evidence suggestive of young and old platelets . J Clin Invest 48:1083-1087, 1969.Crossref 38. Sicuteri F, Del Bianco PL, Anselmi B: Migraine as a cyclic disease with latent and overt components: Effect with antaminic drugs . Headache 10:53-62, 1970.Crossref 39. Curzon G, Barrie M, Wilkinson MIP: Relationship between headache and amine changes after administration of reserpine to migrainous patients . J Neurol Neurosurg Psychiatr 32:555-561, 1969.Crossref 40. Hilton BP, Cumings JN: 5-hydroxytryptamine levels and platelet aggregation responses in subjects with acute migraine headache . J Neurol Neurosurg Psychiatr 35:505-509, 1972.Crossref 41. Sicuteri F, Buffoni F, Anselmi B, et al: An enzyme (MAO) defect on the platelets in migraine . Res Clin Stud Headache 3:245-251, 1972. 42. Moolten SE, Jennings PB, Solden A: Dietary fat and platelet adhesiveness in atherosclerosis and diabetes . Am J Cardiol 11:290-300, 1963.Crossref 43. Bennet PN: Effect of physical exercise on platelet adhesiveness . Scand J Haematol 9:138-141, 1972.Crossref 44. Packham MA, Mustard JF: Platelet reactions . Semin Hematol 8:30-64, 1971. 45. von Kaulla E, Droegemueller W, von Kaulla KN: Effect of estrogens on postpartum hypercoagulability and antithrombin III activity . Am J Obstet Gynecol 113:920-926, 1972. 46. Williams JW, Beutler E, Erslev AJ, et al (eds): Haematology . New York, McGraw-Hill Book Co Inc, 1972.

Journal

Archives of NeurologyAmerican Medical Association

Published: Jan 1, 1975

References