Background: Psychotic patients are at increased risk of thromboembolism that cannot be ascribed to physical restraint or medication. Patients with chronic schizophrenia or long-term depressive illness do not display ischemic brain injuries on magnetic resonance imaging, as expected in patients with thrombotic tendency, but atrophy of specific brain regions, which indicates abnormal neuronal plasticity.
Hypotheses: We postulate that a relationship between psychosis pathophysiology and thrombotic tendency may comprise proteins that participate not only in the anticoagulation-fibrinolysis mechanism, but also in neuronal plasticity.
Case Description: Five psychotic patients with thrombotic episodes on chronic warfarin therapy attained remission of psychotic symptoms and are free of psychotropic medication from 2 to 11years. All patients have at least one thrombophilia related to inhibition of plasminogen activators, including prothrombin G20.210A polymorphism, hyperhomocysteinemia, antiphospholipid antibody syndrome and protein C deficiency.
Discussion: Plasminogen activators participate in blood clot dissolution and tissue repair, such as remodeling of hippocampus after stress, trauma, stroke or seizures. A significant prevalence of both thromboembolism and psychotic events can be seen in circumstances characterized by physiological or pathological inhibition of plasminogen activators, such as puerperium, confinement, polycystic ovary syndrome, antiphospholipid antibody syndrome and chronic inflammatory disorders.
Conclusion: Our findings suggest that normalization of plasminogen activator levels in the brain may induce long-term remission of psychotic symptoms. Randomized controlled studies may help clarify the role of anticoagulation in the treatment of psychosis.
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A randomized trial of low-dose thrombolysis, ultrasound-assisted thrombolysis, or heparin for intermediate-high risk pulmonary embolism-the STRATIFY trial: design and statistical analysis plan.
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Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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From the Center for Stroke Research Berlin (I.G., J.B.F.), Charité-Universitätsmedizin Berlin, Germany; Service de Biostatistique (F.B., P.R.), Hospices Civils de Lyon, France; Department of Neurology (B.C., C.G., G.T.), University Medical Center Hamburg-Eppendorf, France; Department of Stroke Medicine (T.-H.C.), Université Claude Bernard Lyon 1, Hospices Civils de Lyon, France; Neurologie der Rehaklinik Medical Park Humboldtmühle (M. Ebinger), Berlin; Klinik und Hochschulambulanz für Neurologie (M. Endres), Charité-Universitätsmedizin Berlin; Center for Stroke Research Berlin (M. Endres); German Center for Neurodegenerative Diseases (DZNE), partner site Berlin (M. Endres); German Centre for Cardiovascular Research (DZHK), partner site Berlin (M. Endres); German Center for Mental Health (DZPG), partner site Berlin (M. Endres), Germany; Department of Neurology (C.E.), Medical University of Graz, Austria; Department of Diagnostic and Interventional Neuroradiology (J.F.), Universitätsklinikum Hamburg-Eppendorf, Germany; Robertson Centre for Biostatistics (I.F.), University of Glasgow, Scotland; mediri GmbH (J.G.); Fraunhofer Institute for Digital Medicine MEVIS (M.G.), Bremen, Germany; Department of Neurosciences (R.L., A.W.), Experimental Neurology, KU Leuven-University of Leuven, Belgium; School of Psychology & Neuroscience (K.W.M.), University of Glasgow, Scotland; Department of Stroke Medicine (N.N.), Université Claude Bernard Lyon 1, and Hospices Civils de Lyon, France; Department of Neurology (C.Z.S.), Aarhus University Hospital, Denmark; Florey Institute of Neuroscience and Mental Health (V.N.T.), Heidelberg, Australia; and Institut d'Investigació Biomèdica de Girona (S.P.), Hospital Universitari Doctor Josep Trueta, Girona, Spain.
Background And Objectives: Data from randomized trials on the treatment effect of pure thrombolysis in patients with vessel occlusion are lacking. We examined data from a corresponding subsample of patients from the multicenter, randomized, placebo-controlled WAKE-UP trial to determine whether MRI-guided IV thrombolysis with alteplase in unknown-onset ischemic stroke benefits patients presenting with vessel occlusion.
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Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA.
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Canadian VIGOUR Centre (K.R.B., R.C.W., Y.Z., T.T., E.L., C.M.W., P.W.A.), University of Alberta, Edmonton, Canada.
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Department of Emergency, Can Tho S.I.S General Hospital, Can Tho, Vietnam.
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