Hypercoagulability: A Possible Mechanism for Acute Ischemic Stroke with Non-transfusion-dependent β Thalassemia

Objective: In this study, we aimed to investigate the clinical characteristics of acute ischemic stroke (AIS) patients with non-transfusion-dependent thalassemia (NTDT), expecting to provide evidence and clues for the potential associations of AIS with NTDT. Methods: We recruited 28 AIS patients with NTDT from October 1, 2007, to June 1, 2022 as the case group. The case group patients were individually categorized into non-transfusion dependent β-thalassemia group and non-transfusion dependent α-thalassemia group. Clinical and biological findings were compared between the case group and a consecutive cohort of 76 non-thalassemia patients who were admitted for an AIS during January 1, 2021, and January 31, 2021. Results: Compared to the control group, the non-transfusion dependent β-thalassemia group had significantly higher levels of D-dimer, fibrinogen, erythrocyte sedimentation rate and serum ferritin on admission (all p＜0.05). The primary ischemic stroke etiological subtype in the non-transfusion dependent β-thalassemia group was small vessel occlusion (SVO) which was significantly higher than that the controls (77.3% vs. 30.3%, p=0.001). Fasting blood glucose and glycosylated haemoglobin levels on admission were significantly lower in the non-transfusion dependent α-thalassemia group when compared to those in the non-transfusion dependent β-thalassemia group and in the control group (all p＜0.05). Conclusion: The level of D-dimer and fibrinogen were significantly higher in the non-transfusion dependent β-thalassemia group than those in the control group, suggesting that AIS patients with non-transfusion dependent β-thalassemia may have a hypercoagulable state. The most common ischemic stroke etiological subtype in the non-transfusion dependent β-thalassemia group was SVO.