Ischemic Stroke with Protein S Deficiency Treated by Apixaban

Ikkei Ohashi, Shinichi Wada, Fumitaka Yoshino, Takahiro Kuwashiro, Shinya Matsumoto, Taeko Hotta, Dongchong Kang, Yasushi Okada, Shun Shimohama, Masahiro Yasaka

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


A 57-year-old man with atherosclerosis obliterans was admitted with sudden-onset sensory aphasia and right hemiparesis. Brain MRI revealed acute cerebral infarctions in the left temporal lobe and magnetic resonance angiography showed occlusion of the posterior branch of the left middle cerebral artery. Transesophageal echocardiography and ultrasonography respectively confirmed a patent foramen ovale and deep vein thrombosis in the bilateral femoral veins. Blood findings showed low protein S antigen, low protein S activity, and a missense mutation of the PROS 1 gene. The administration of apixaban 10 mg BID prevented ischemic stroke recurrence and decreased the deep vein thrombosis. These outcomes indicated that apixaban may be alternative to warfarin for the secondary prevention of ischemic stroke in a patient with a protein S deficiency.

Original languageEnglish
Article number104608
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number4
Publication statusPublished - Apr 2020

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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