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.”
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