Hemostatic Alterations in Cerebrovascular Insufficiency

Abstract

Understanding of hemostatic alterations is relevant to the problem of treatment of TIAs and prevention of stroke. In fact, not all of cerebrovascular pathology is caused by embolic or atherothrombotic processes, and a single treatment may not necessarily be effective for all categories of TIA patients. The aim of studying platelet function is to try to identify patients potentially “responsive” and “unresponsive” to antiplatelet drugs, and to evaluate the strategies for treatment, by this meaning the drug(s) and drug schedule of choice. This will never be attained, however, without a preselection of patients based on identification of the pathogenetic mechanisms and the specific risk of stroke. For example, the inhibition of platelet thrombi by drugs or diets that interfere with any component of the atherothrombotic process would not necessarily be expected to influence the natural history of TIAs due to hemodynamic mechanisms, or due to advanced and severe diffuse disease of the cerebral arteries, or to embolism of calcific material from malfunctioning heart valves, nor perhaps to prevent embolization from thrombus within the heart chambers. Natural history of such subgroups of patients, ex vivo effect of antiplatelet drugs on hemostatic functions in the same, and perspective for enhanced pharmacological prevention of stroke will be the object of further studies.