Q. What is the cause of my recurrent strokes and TIA?

Answered by
Dr. Singh Smrita
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 24, 2018

Hello doctor,

I am a 65 year old female with hypercoagulation. What is the root cause of hypercoagulation and can it be treated so the condition goes away? My fibrinogen, antithrombin III, and D Dimer are elevated and my TEG platelet mapping shows hypercoagulation. I am taking Coumadin 5 mg per day. I did some research and learned that elevated fibrinogen could be the result of chronic inflammation from atherosclerosis, which I have. Other causes might be cancer or arthritis, which I do not have. Can you think of anything else that might be causing it and have you any ideas on how to reverse it permanently? I do not want to take Coumadin for the rest of my life if I can help it.

Background: I have a history of a dozen lacunar strokes in different parts of my brain (sometimes in several places at once) and many TIAs over the past three years, for which I have received tPA, and after which the stroke symptoms resolved with minimal lasting deficits (left hip is still weak).

Recently, I went to a hematologist to see if I could find the cause of the strokes and TIAs. He did an extensive workup and told me my blood protein is all screwed up. I assumed he meant fibrinogen. He diagnosed me with hypercoagulation and put me on Lovenox shots for two weeks, then transitioned me to Coumadin six weeks ago. Since then, the strokes and TIAs have stopped.

My normal blood tests: Protein S, Protein C, Factor V Leiden, IGG/IGA/IGM, Anticardiolipin Antibody, Thrombin Time, Lupus Anticoagulant, DRVVT, Heparin Level, APPT, Protime-INR, PFA, Homocysteine, Cortisol, C Reactive Protein, Troponin I, Prothrombin DNA, PT, PTT.My atherosclerosis: CTA and MRA show there are no problems in the vessels of my heart or neck, but mild to severe stenosis in various vessels of my brain, notably the basilar artery (balloon angioplasty reduced it from 90 % to 50 %) and the right anterior cerebral artery (is 90 % but they cannot do angioplasty because they say it is too difficult). I have small vessel disease in my white matter.



Welcome to

Your elevated antithrombin 3 and D-dimer levels are a direct consequence of the stroke you suffered and the many TIAs. High fibrinogen levels are associated with an increased incidence of blood clots.

The treatment that you are receiving currently is to prevent the formation of blood clots. Unfortunately, the only way you can reverse it completely is to reverse your hypertension and atherosclerosis. Atherosclerosis in older individuals and those with a prolonged duration of the disease is usually irreversible.

You need to keep taking the medication since it prevents the development of clots and will help prevent them in the blood vessels in the brain. If they are allowed to develop, they can be fatal.

For more information consult a hematologist online -->

Hello doctor,

Thank you for your answer. You have confirmed what I thought about fibrinogen. You also confirmed that my strokes/TIAs caused the elevated antithrombin III and D Dimer. So, there is nothing I can do about that. I do not want to give up on reversing my hypertension and atherosclerosis, even at my age of 65. What in your experience is capable of reversing them? I have tried to address this myself by embarking on daily meditation, a vegan diet without sugar, refined carbohydrates or vegetable oils (except olive oil and coconut oil), various herbs and vitamins known to help the brain and circulation, and daily walking outside. I joined a gym and hired a personal trainer, and will start as soon as I finish the physical therapy for my weak left hip (from a stroke).



Welcome to

I think that the measures you are taking to improve your health are commendable. I will ask you to avoid using coconut oil in your diet. Olive oil is good. But keep in mind that the amount of fat from oils should be kept to a minimum. You can instead eat a portion of nuts. Adding fish to your diet would be great too. Omega 3 fatty acids are good for your heart and blood vessels in addition to your skin.

You can add yoga too to help with your balance which helps your nervous system.

If you have any further questions, you can always contact me.

For more information consult a hematologist online -->

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