Establishing the correct management in a patient with multiple cryptogenic strokes: Antiplatelet vs. anticoagulant therapy

Abstract

Cryptogenic strokes represent a category of ischemic strokes in which there is no well-defined cause identified. For that matter, choosing between antiplatelet and anticoagulant therapy can be challenging. We present the case of a 44-year-old Caucasian male with a history of multiple ischemic strokes, with thrombophilia, but no atrial fibrillation or known cardio-embolic sources, who initially received anticoagulant treatment, which was switched in 2015 with Clopidogrel. Aspirin was added in 2017 after having a TIA in the left MCA territory. Despite dual antiplatelet therapy, the patient developed ischemic stroke in the left MCA territory, for which re-initiation of anticoagulant treatment was decided. Holter ECG, transthoracic and transesophageal echocardiography were performed, but failed to identify a cause.

Keywords

• cryptogenic stroke
• thrombophilia
• antiplatelet
• anticoagulant