title: Ischaemic stroke following tranexamic acid in young patients carrying heterozygosity of MTHFR C677T.
abstract: The objective of this study is to report a new manifestation of acute stroke following antifibrinolytic agent administration in young women carrying heterozygosity for methylene-tetrahydrofolate reductase (MTHFR) C677T. The study included two young women who developed an acute ischaemic stroke following three days of tranexamic acid administration for bleeding gynaecological disorders. Case 1, a 44-year-old woman, presented left hemiplegia, mild dysarthria and anosognosia. Brain magnetic resonance imaging showed right ischaemic fronto-temporal lesion due to subocclusion of the right middle cerebral artery. Case 2, a 49-year-old woman, developed aphasia and right hemiplegia. Neuroimaging showed left capsular and periventricular infarcts due to near occlusion of the left internal carotid artery. Thrombophilia screening, coagulation parameters, homocysteine testing, 12-lead electrocardiography, and transthoracic and transoesophageal echocardiography were unremarkable. Genetic assay showed that both patients carried heterozygosity for MTHFR C677T, in which cytosine (C) is replaced by thymidine (T) at base position 677. To our knowledge, this is the first report describing the association between genetic factors and the onset of stroke following antifibrinolytic drugs intake. These data suggest a synergic effect of plasminogen activator inhibitor and heterozygosity for MTHFR C677T on the pathogenetic mechanisms leading to ischaemic stroke in young people.
authors: Stroke Unit, Sapienza University, Rome, Italy.
authors: Katiuscia
authors: K
authors: Nardi
authors: Giordana
authors: G
authors: Pelone
authors: Michelangelo
authors: M
authors: Bartolo
authors: Maria Rita
authors: MR
authors: Di Ruzza
authors: Marianna
authors: M
authors: Storto
authors: Antonella
authors: A
authors: Notte
authors: Giovanni
authors: G
authors: Grillea
authors: Claudio
authors: C
authors: Colonnese
authors: Giuseppe
authors: G
authors: Lembo
authors: Carmine
authors: C
authors: Vecchione
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000139:chemically induced / Q000175:diagnosis* / Q000235:genetics; D018810:Magnetic Resonance Angiography; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D020125:Mutation, Missense; D011859:Radiography; D014148:Tranexamic Acid / Q000009:adverse effects*
chemical_list: D014148:Tranexamic Acid; D042965:Methylenetetrahydrofolate Reductase (NADPH2)