Four patients ages 20 to 38 years had repeated cerebrovascular occlusions. Three of the four patients had vascular headaches (classical migraine in two) for some years before their first occlusive event occurred. When first seen at the time of their major cerebrovascular occlusion, all had evidence of plasma hypercoagulability, and two of the women were receiving birth control pills.
Many months later, while off the "pill" and on warfarin sodium (Coumadin) therapy, two women and one man continued to have new cerebrovascular symptoms. For the first time, their platelet aggregability was tested to several biological substances known to come in contact with platelets in vivo. At this time, all four patients were found to have platelet hyperaggregability. The three symptomatic patients also had a shortened platelet survival time. Long-term management of these patients with chronic platelet aggregability and chronic plasma hypercoagulability is described.