Elevated Platelet Microparticle Levels after Acute Ischemic Stroke with Concurrent Idiopathic Thrombocytopenic Purpura

• Published in: Journal of stroke and cerebrovascular diseases Vol. 23; no. 3; pp. 587 - 589
• Main Authors: Ichijo, Masahiko, MD, Ishibashi, Satoru, MD, PhD, Ohkubo, Takuya, MD, PhD, Nomura, Shosaku, MD, PhD, Sanjo, Nobuo, MD, PhD, Yokota, Takanori, MD, PhD, Mizusawa, Hidehiro, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2014
• Subjects: Blood Platelets - drug effects; Blood Platelets - pathology; Cardiovascular; Cell-Derived Microparticles - drug effects; Cell-Derived Microparticles - pathology; Cerebral Angiography - methods; Cyclosporine - therapeutic use; Dexamethasone - therapeutic use; Diffusion Magnetic Resonance Imaging; Female; Glucocorticoids - therapeutic use; Humans; Idiopathic thrombocytopenic purpura; Immunosuppressive Agents - therapeutic use; Infarction, Middle Cerebral Artery - blood; Infarction, Middle Cerebral Artery - complications; Infarction, Middle Cerebral Artery - diagnosis; Infarction, Middle Cerebral Artery - drug therapy; ischemic stroke; Magnetic Resonance Angiography; Middle Aged; Neurology; Platelet Aggregation Inhibitors - therapeutic use; platelet microparticles; Prednisolone - therapeutic use; Purpura, Thrombocytopenic, Idiopathic - blood; Purpura, Thrombocytopenic, Idiopathic - complications; Purpura, Thrombocytopenic, Idiopathic - diagnosis; Purpura, Thrombocytopenic, Idiopathic - drug therapy; Tetrazoles - therapeutic use; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Up-Regulation; Idiopathic thrombocytopenic purpura; platelet microparticles; ischemic stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.032

We report a 60-year-old woman with idiopathic thrombocytopenic purpura who experienced acute infarction of the middle cerebral artery. She was treated with an antiplatelet agent and prednisolone to limit platelet activation and destruction. In parallel with clinical amelioration, levels of plasma platelet microparticles (PMPs), a procoagulant factor in platelet activation, decreased after treatment but increased after reduction of the prednisolone dose, resulting in progression of vascular stenosis. Immunosuppressive therapy with cyclosporine normalized plasma PMP levels, and no additional vascular events occurred during the 3-month follow-up period. Immunosuppressive therapy to decrease plasma PMP levels is warranted after acute ischemic stroke in the context of idiopathic thrombocytopenic purpura.