Resistance to activated protein C as an etiology for stroke in a young adult: a case report. uri icon

Overview

abstract

  • Resistance to activated protein C (R-APC) is an inherited, autosomal dominant, coagulation abnormality that is increasingly recognized as an important etiology for thromboembolic disease and stroke in young adults. This report describes the case of a 27-year-old woman taking oral contraceptives who experienced an acute thrombotic right hemispheric stroke. Three days after rehabilitation admission (33 days after stroke) she developed a left femoral deep venous thrombosis (DVT) despite appropriate prophylaxis. Further diagnostic workup for the stroke and DVT identified R-APC, possibly exacerbated by oral contraceptives, as the etiology. Hematology consultation recommended lifetime anticoagulation with warfarin. The patient's family history revealed that a 19-year-old cousin had died of a stroke several years earlier. Several months after discharge, an acute DVT occurred in the patient's 28-year-old brother, who tested positive for factor V Leiden, a genetic abnormality closely associated with R-APC. A thrombotic stroke occurred in her grandfather a few months later, but he was not tested. Her father demonstrated a "borderline" positive R-APC test and probably represents the genetic link. Indications for patient and family screening regarding R-APC and other forms of hereditary thrombophilia and implications for rehabilitation medicine physicians are discussed.

publication date

  • March 1, 1999

Research

keywords

  • Activated Protein C Resistance
  • Intracranial Embolism and Thrombosis

Identity

Scopus Document Identifier

  • 0032978198

Digital Object Identifier (DOI)

  • 10.1016/s0003-9993(99)90149-1

PubMed ID

  • 10084446

Additional Document Info

volume

  • 80

issue

  • 3