Acute ischemic stroke in myeloproliferative neoplasia: Using molecular pathophysiology knowledge to treat prothrombotic state with direct oral anticoagulants

Myeloproliferative neoplasms (MPN) are defined by clonal expansion of hematopoietic progenitor cells and often associated with systemic thrombosis. Arterial thrombi due to MPN have a multifactorial etiology and are typically managed with antiplatelet agents. However, recent mechanistic studies on patients with JAK2V617F mutations have demonstrated alterations in cellular heparanase activity that results in a hypercoagulable state. We report a patient with MPN presenting with acute ischemic stroke caused by a basilar artery thrombus due to JAK2V617F mutation related hypercoagulability. Newer direct oral anticoagulants may be appropriate for secondary stroke prevention in such cases.