Medical Management of a Mural Thrombus Inducing Repeated Ischemic Strokes in a Patient with Congenital Afibrinogenemia.
Summary: This article reviewed the case of a patient with congenital afibrinogenemia (blood does not clot normally due to the lack of fibrinogen) with a mural thrombus (blood clot formed within the blood and attached to the wall of a blood vessel or to the lining of a chamber of the heart) inducing repeated ischemic strokes (occurs when a vessel supplying blood to the brain is obstructed) treated with an antiplatelet agent (medicine that prevents blood clots from forming) and fibrinogen (a blood protein necessary for clotting) replacement.
Conclusion: The patient was successfully treated with an antiplatelet agent (medicine that prevents blood clots from forming) and fibrinogen (a blood protein necessary for clotting) replacement.
Objective: Congenital afibrinogenemia is an autosomal recessive inherited disorder that can cause thrombotic as well as hemorrhagic events. We describe a case of repeated mild ischemic strokes due to a mural thrombus in the carotid artery and our medical treatment.
Methods: A 49-year-old woman with congenital afibrinogenemia developed two minor ischemic strokes in two months. Clinical images revealed scattered fresh infarcts in the right middle cerebral artery region and mild cervical carotid artery stenosis. The risk for surgical treatment was considered to be extraordinarily high. The patient was treated with 100 mg/day of aspirin and 3 g fibrinogen infusion every two weeks. After the one-year course of medication, the mural thrombus gradually decreased, and there were no bleeding or ischemic stroke events.
Conclusions: This case report highlights the successful treatment of an ischemic stroke in a patient with a congenital afibrinogenemia with an antiplatelet agent and fibrinogen replacement. There are no guidelines for managing ischemic stroke in patients with congenital afibrinogenemia, and further studies are needed.