A Seeming Paradox

Abstract

Nowadays, we have a relatively sophisticated standard approach to a patient with acute ischemic stroke, including the sequence of diagnostic methods and treatment modalities. In practice, however, we are occasionally confronted with a patient whose medical history or comorbidities force us to make a decision without the support of guidelines. One such situation is the occurrence of acute ischemic stroke in a patient with known idiopathic thrombocytopenic purpura, where a tendency to use thrombolysis, anticoagulants, or antiplatelet agents collides with the fear of life-threatening bleeding. In this review, we try to outline current understanding of the pathophysiology of "paradoxical" ischemic events in this illness characterized by thrombocytopenia and to summarize clinical experience from case reports dealing with this topic, which could help us to rely on more than individual opinion seen through a purely "neurological" or "hematological" prism.

Treatment of Acute Ischaemic Stroke and Concomitant Multiple Arterial Splanchnic Thromboses in a Patient with Immune Thrombocytopenia on Thrombopoietin Agonist: A Case Report

“…Twenty-four articles were eligible and were included in the review [ 1 , 2 , 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. We identified three case reports [ 1 , 9 ] and three review articles [ 1 , 9 , 10 ] on AIS treatment with IVT in patients with ITP.…”

“…Twenty-four articles were eligible and were included in the review [ 1 , 2 , 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. We identified three case reports [ 1 , 9 ] and three review articles [ 1 , 9 , 10 ] on AIS treatment with IVT in patients with ITP. Thirteen articles addressed thrombotic complications in ITP patients [ 5 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], and eight articles detailed the thrombotic complications of TPO treatment in ITP patients [ 2 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

“…Twenty-four articles were eligible and were included in the review [1,2,5,. We identified three case reports [1,9] and three review articles [1,9,10] on AIS treatment with IVT in patients with ITP. Thirteen articles addressed thrombotic complications in ITP patients [5,[11][12][13][14][15][16][17][18][19][20][21][22], and eight articles detailed the thrombotic complications of TPO treatment in ITP patients [2,[23][24][25][26][27][28][29].…”