Gerinnungsstörungen und Schlaganfall

Zusammenfassung

Hereditäre und erworbene Gerinnungsstörungen können bei der Schlaganfallentstehung eine wichtige Rolle spielen. Wegen der Seltenheit der meisten erblichen Gerinnungsstörungen und der erheblichen Kosten, die sich aus einer unkritischen Indikationsstellung ergeben, ist eine maßgeschneiderte Diagnostik sinnvoll. Suggestive Hinweise auf eine Gerinnungsstörung sind niedriges Lebensalter, mehrfache Thrombosen in der Anamnese, altersuntypische Gefäßdegenerationen, vorherige Aborte bei Schlaganfallpatientinnen oder strukturelle Herzveränderungen (z. B. offenes Foramen ovale). Störungen von AT III, Protein C und S, APC-Resistenz, Prothrombinmutation, Homocysteinämie, Antiphospholipidantikörper und prokoagulatorische zelluläre Interaktionen werden diskuiert.

Summary

Hereditary and acquired coagulation disorders may play an important role in the pathophysiology of acute ischaemic stroke. Because of the low prevalence of these disorders and the considerable costs of unmindful diagnostic effort, a custom- tailored approach is desirable. Suggestive in favour of a possible prothrombotic clotting disorder are young patients, repeated episodes of thrombosis in the patient’s history, inappropriate atherosclerotic vascular changes, previous repeated miscarriages in stroke patients, or structural cardiac abnormalities as a patent foramen ovale. Disorders affecting antithrombin III, protein C und S, APC-resistance, the prothrombin mutation, homocysteinaemia, antiphospholipid antibodies, and procoagulatory cellular interaction are discussed.

Schlüsselwörter

Schlaganfall - Gerinnungsstörung - Thrombophilie

Keywords

Ischaemic stroke - coagulation disorders - thrombophilia

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