To the Editor.
—Adams et al1 uncovered 44 patients with acute, cerebral thromboembolic events in a group of 140 patients with postrenal transplant neurologic complications. The underlying cause for 19 of 29 strokes and two of 11 transient ischemic attacks was unknown, though the authors postulated atherosclerosis. They cited but did not specify coagulation disorders in three of 29 strokes and two of 11 transient ischemic attacks. The summary listed erythrocytosis and hyperfibrinogenemia among the hematologic abnormalities found in renal transplant recipients. We believe that some of these unexplained events may be precipitated by a quantitative defect in antithrombin III, due to either pretransplant or posttransplant proteinuria, giving rise to a hypercoagulable state.2,3 Nephrosis heralds diabetic nephropathy, accompanies polycystic kidney disease, and occurs in the posttransplant period. The authors may want to test urine sediment, urine, and blood levels of antithrombin III. Treatment with warfarin sodium would not be indicated
Fisher L, Kotsoris H. Stroke in Renal Transplant Recipients. Arch Neurol. 1986;43(8):755–756. doi:10.1001/archneur.1986.00520080007004
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