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PSD and Small Vessel Disease


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Hi All,

I recently had an MRI to rule out some other issues and was diagnosed with microangiopathy, or "small vessel disease".  Apparently, these are tiny clots in the brain that cause "microbleeds" and can affect cognition over time.  The usual causes of this condition are high blood pressure and/or diabetes and it is usually seen in patients over 60. I am only 48 and have neither of these conditions. (I actually have low blood pressure.)  My Dr. ordered a bunch of blood tests and the only thing abnormal was a functional Protein S of 23, so I guess I have PSD.  My Dr. decided that this is what must be causing the microbleeds and put me on Xarelto.  I should say I have never otherwise had any thrombosis, and though my parents haven't been tested for PSD, as far as I know, thrombosis doesn't run in my family. I did a little research on my own and it seems there and mixed opinions on whether Xarelto (or any anticoagulant) is really safe for someone with small vessel disease, as while it helps with clotting, if the microbleeds continue, it could lead to serious brain hemorrhage.  I've also seen very little research linking small vessel disease with PSD, even though intuitively it makes some sense.  I should disclose that I'm an American living in Mexico so I don't have total confidence in the medical care I'm receiving here.  I'm wondering if anyone else on the Forum has also been diagnosed with cerebral microangiopathy or small vessel disease associated with PSD, or if anyone knows anything about a link between the two.  Putting that issue aside, does it make sense to be taking an anticoagulant if I've never had an episode of DVT?  I'd really appreciate any thoughts or guidance on this.  Thanks!

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Anticoagulants are normally only prescribed if you have a history of thrombosis. Many people have low Protein S levels and do not get a clot.

I do not know about microangiopathy but I can see it relates to the endolethium. The endolethium is known to play a role in production of Protein S. So maybe it is the other way around, the problem with the endolethium is causing a reduction in your Protein S levels.

Family testing would probably be helpful in understanding whether anyone else in your family has low Protein S levels like yourself. If anyone does then it would indicate a hereditary cause, rather than caused by a health condition.

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Hi James!  Thanks so much for your response.  You say that it is generally more common for an anticoagulant to be prescribed only with a history of thrombosis.  Is it also your sense that it is more common for one to be prescribed in the case of hereditary PSD rather than acquired or doesn't it make a difference?  I will see about having my parents tested.  In the mean time, is there any use in trying to determine what "type" of PSD I have?  I think my Dr. only tested fuctional PS.   

I didn't know about the role of endolethium in Protein S production so that's a very interesting angle for me to pursue.  Since there's no history of DVT in my family I'm suspecting that I have acquired PSD and will definitely look at that angle.  If you happen to know of any good sources with more information on endolethium breakdown and why it happens, I'd love to know about them, meanwhile, I'm doing my own searches.  For now, I've seen smoking, high blood pressure and diabetes as causes, none of which are relevant to my case...

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There is not much point in determining the type of PSD. Doctors prescribe anticoagulants to reduce the risk of thrombosis. They don’t do anything to treat the PSD. Unless you are facing a situation which significantly increases the risk of clotting it is unlikely they will prescribe anything unless you have previously suffered from thrombosis.

There was no history of DVT in my family apart from myself. However my mother, sister and niece all have PSD like me. Only blood tests of family members will tell you for sure.

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  • 1 year later...

Hi James,

I am the first in my family to be diagnosed with PSD  My sister was tested and has the possibility but no symptoms yet.  I am now switched from coumadin to Pradaxa for life.  I have had 4 previous clots, 3 after taking coumadin so that is why I now have Pradaxa.  I need to learn more about this condition and drug so that is why I am on this site.  Anything you learn and can pass on will be greatly appreciated.  Do you know if the University fof N C has any new info?  

Thanks, Lois Lynda

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  • 1 year later...

Check your family history for strokes, aneurysms, heart attacks and pulmonary embolisms. We found multiples of these as far back in the line of family (that was documented) this comes from. We actually traced it back to the Ayers family of three who came to America on the Mayflower.

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