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Heghine Khachatryan: Microthrombosis and the ‘Silent Brain Injury’ Paradigm
Heghine Khachatryan/LinkedIn
Mar 31, 2026, 14:50

Heghine Khachatryan: Microthrombosis and the ‘Silent Brain Injury’ Paradigm

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:

”Microthrombosis and the ‘Silent Brain Injury’ Paradigm

In recent years, growing evidence has positioned microthrombosis not merely as a vascular phenomenon, but as a central driver of subclinical brain injury and progressive cognitive decline.

‘Silent microthrombosis’ represents a critical yet underrecognized mechanism linking hemostasis, inflammation, and neurodegeneration.

Key Insight

Conventional neuroimaging — particularly MRI — systematically underestimates the true burden of microvascular injury.
What remains ‘invisible’ radiologically may still exert profound biological effects.

Pathophysiologic Axis

  • Endothelial dysfunction leads to microvascular occlusion
  • Platelet activation and fibrin deposition
  • Neuroinflammation and BBB disruption
  • Progressive neuronal injury without overt stroke

Clinical Relevance

This mechanism is increasingly recognized across high-risk states:

  • COVID-19–associated coagulopathy
  • Cancer-associated thrombosis (Trousseau spectrum)
  • Antiphospholipid syndrome (APS)

Why it matters

We may be underdiagnosing a silent epidemic of brain injury, where patients present not with stroke — but with gradual cognitive decline, fatigue, or subtle neurologic dysfunction.

This challenges us to rethink:

  • The limits of imaging-based diagnostics
  • The need for integrated hemostatic and neurovascular assessment
  • The role of early preventive strategies targeting microthrombosis

A shift is emerging:
From visible stroke to invisible vascular injury with long-term cognitive consequences.”

Heghine Khachatryan: Microthrombosis and the 'Silent Brain Injury' Paradigm

Other posts featuring Heghine Khachatryan on Hemostasis Today.

Antiphospholipid Syndrome APS Cancer Associated Thrombosis Covid-19 Headlines Health Heghine Khachatryan Hematology Hemostasis Hemostasis News Hemostasis Today Medicine Microthrombosis microvascular occlusion Trousseau spectrum
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