Ischemic Strokes in Congenital Bleeding Disorders: Comparison with Myocardial Infarction and other Acute Coronary Syndromes

Objective: To investigate the occurrence of ischemic stroke in patients with congenital bleeding disorders. Patients and Methods: Patients with congenital bleeding disorders who presented an objectively proven ischemic stroke were obtained by means of a time unlimited Pubmed search. Appropriate key words and Medical subject headings were used. Cross-checking of the references was also carried out. Results: There were four cases of Fibrinogen defects or Factor VII deficiency; seven patients had Hemophilia (6 hemophilia A and 1 hemophilia B); eight cases of FXI deficiency and six patients with von Willebrand Disease. One patient had a congenital platelet disorder. Age varied from 7 to 80 (mean age 38.6). 15 were male and 11 female. In four patients gender was not reported. The ratio of Myocardial Infarction to Ischemic stroke was 12.28 for the hemophilias, 7.83 for vW Disease and 2.75 for the Rare Bleeding Disorders. Risk factors were present in most patients, replacement therapy and old age being the most frequent. Conclusions: The differences in the prevalence of ischemic stroke vs coronary arterial disease seen in patient with congenital bleeding disorders indicate that clotting defects assure an uneven protection from atherothrombosis. Since the mechanisms underlying these differences are unknown, they represent a field of potential future investigation.