Immunosuppressive medications such as the mTOR inhibitors have been shown to cause prothrombotic states in allograft recipients, possibly due to increased endothelial cell activation and impaired fibrinolysis. Everolimus increases venous thromboembolism risk in lung transplantation patients. Cyclosporine is also known to increase the prothrombotic state. Ischemic stroke can be a manifestation of this prothrombotic state. Elevated homocysteine is also an independent risk factor for vascular events. Specifically, 85-100% patients with ESRD have hyperhomocysteinemia, and have higher rates of cardiovascular mortality than the general population.

There is scant literature on immunosuppressive therapy as risk for thromboembolic ischemic events. Moreover, isolated hyperhomocysteinemia is an under-reported complication of renal failure from GVD and increases risk for ischemic events. This case notes the importance for further studies on the role of immunosuppressive therapy in stroke etiology in patients with GVD to consider for stroke prevention.