Yang Diana, Shriram Anjana, Ra Yu Lee, Rivas Cindy, Elahi Ava, Gorospe Christopher James, Ho Jocelyn, Pereira Benedict, Song Shlee, Simpkins Alexis N
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Neurology, University of Florida, Gainesville, FL, USA.
J Stroke Cerebrovasc Dis. 2025 Aug;34(8):108364. doi: 10.1016/j.jstrokecerebrovasdis.2025.108364. Epub 2025 May 28.
This case highlights the importance of considering platelet function and aggregability in patients with recurrent ischemic stroke and deep vein thrombosis.
We present a case of a 47-year-old man with history of hypertension, hyperlipidemia, and multiple thrombotic events but no family history of clotting events. Over a period of eight years, he was diagnosed with deep vein thrombosis, pulmonary embolism, and occipital lobe, cerebellar, and parietal lobe infarcts. After presenting with new embolic strokes, platelet aggregometry demonstrated hyperactivity to three agonists, including adenosine-diphosphate (ADP)- indicative of Sticky Platelet Syndrome. Repeat platelet aggregometry demonstrated poor response to clopidogrel, so the patient was discharged on triple therapy with aspirin, clopidogrel, and enoxaparin to warfarin bridge. Two years later, the patient was diagnosed with right eye central retinal artery occlusion two months after an outpatient provider discontinued the clopidogrel and switched warfarin to apixaban. He was discharged back on triple therapy with re-initiation of clopidogrel and apixaban switched to warfarin.
Thrombosis in unusual sites and despite anticoagulant use, coupled with platelet hyperactivity to ADP, were suggestive of Sticky Platelet Syndrome. Due to lack of testing standardization, diagnosis of a persistent, hyperreactive platelet phenotype remains challenging. However, improvements in diagnostic approaches for Sticky Platelet Syndrome can be highly beneficial in enabling faster treatment with an appropriate antithrombotic regimen, reducing the risk of subsequent thrombotic events.
本病例强调了在复发性缺血性中风和深静脉血栓形成患者中考虑血小板功能和聚集性的重要性。
我们报告一例47岁男性，有高血压、高脂血症病史及多次血栓形成事件，但无凝血事件家族史。在八年时间里，他被诊断为深静脉血栓形成、肺栓塞以及枕叶、小脑和顶叶梗死。在出现新的栓塞性中风后，血小板聚集试验显示对三种激动剂（包括二磷酸腺苷（ADP））反应亢进，提示存在血小板黏附综合征。重复血小板聚集试验显示对氯吡格雷反应不佳，因此患者出院时接受阿司匹林、氯吡格雷和依诺肝素三联治疗，并过渡到华法林治疗。两年后，在门诊医生停用氯吡格雷并将华法林换为阿哌沙班两个月后，患者被诊断为右眼视网膜中央动脉阻塞。他再次接受三联治疗，重新启用氯吡格雷，并将阿哌沙班换回华法林。
在不寻常部位发生血栓形成且尽管使用了抗凝剂，再加上血小板对ADP反应亢进，提示存在血小板黏附综合征。由于缺乏检测标准化，持续存在的高反应性血小板表型的诊断仍然具有挑战性。然而，血小板黏附综合征诊断方法的改进对于能够更快地采用适当的抗血栓治疗方案进行治疗、降低后续血栓形成事件的风险可能非常有益。
