Heghine Khachatryan: Hidden Hematologic Causes of Cryptogenic Stroke
Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn:
”The Hematologic Landscape of Cryptogenic Stroke: Identifying Hidden Causes of Cerebral Ischemia
Cryptogenic Stroke: When the Cause Lies in the Blood
Up to 20–30% of ischemic strokes are classified as cryptogenic — meaning that no clear cause is identified despite comprehensive evaluation.
However, a growing body of evidence suggests that hematologic and hemostatic disorders may account for approximately 10–15% of these cases, particularly in younger patients and those with recurrent or unexplained thrombotic events.
Key hematologic conditions associated with cryptogenic stroke include:
- Antiphospholipid syndrome — one of the most important immune-mediated causes of arterial thrombosis and stroke
- Factor V Leiden mutation
- Prothrombin G20210A mutation
- Deficiencies of natural anticoagulants (protein C, protein S, antithrombin)
- Hyperhomocysteinemia
- Paroxysmal nocturnal hemoglobinuria
- Myeloproliferative neoplasms associated with JAK2 mutations
- Cancer-associated thrombosis, including Trousseau syndrome
Recognizing these conditions is critical.
Identifying an underlying hematologic mechanism not only clarifies the cause of stroke but can significantly influence secondary prevention strategies and long-term management.
For clinicians evaluating cryptogenic stroke, a targeted hematologic work-up may reveal an otherwise hidden prothrombotic state.
Earlier detection means better prevention.”
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