question: Hello doctor,I am a 65 year old female with hypercoagulation. What is the root cause of hypercoagulation and can it be treated so the condition goes away? My fibrinogen, antithrombin III, and D Dimer are elevated and my TEG platelet mapping shows hypercoagulation. I am taking Coumadin 5 mg per day. I did some research and learned that elevated fibrinogen could be the result of chronic inflammation from atherosclerosis, which I have. Other causes might be cancer or arthritis, which I do not have. Can you think of anything else that might be causing it and have you any ideas on how to reverse it permanently? I do not want to take Coumadin for the rest of my life if I can help it.Background: I have a history of a dozen lacunar strokes in different parts of my brain (sometimes in several places at once) and many TIAs over the past three years, for which I have received tPA, and after which the stroke symptoms resolved with minimal lasting deficits (left hip is still weak).Recently, I went to a hematologist to see if I could find the cause of the strokes and TIAs. He did an extensive workup and told me my blood protein is all screwed up. I assumed he meant fibrinogen. He diagnosed me with hypercoagulation and put me on Lovenox shots for two weeks, then transitioned me to Coumadin six weeks ago. Since then, the strokes and TIAs have stopped.My normal blood tests: Protein S, Protein C, Factor V Leiden, IGG/IGA/IGM, Anticardiolipin Antibody, Thrombin Time, Lupus Anticoagulant, DRVVT, Heparin Level, APPT, Protime-INR, PFA, Homocysteine, Cortisol, C Reactive Protein, Troponin I, Prothrombin DNA, PT, PTT.My atherosclerosis: CTA and MRA show there are no problems in the vessels of my heart or neck, but mild to severe stenosis in various vessels of my brain, notably the basilar artery (balloon angioplasty reduced it from 90 % to 50 %) and the right anterior cerebral artery (is 90 % but they cannot do angioplasty because they say it is too difficult). I have small vessel disease in my white matter.