Sex differences in stroke: The contribution of coagulation

Abstract

Stroke is now the leading cause of adult disability in the United States. Women are disproportionately affected by stroke. Women increasingly outnumber men in the elderly population, the period of highest risk for stroke. However, there is also a growing recognition that fundamental sex differences are present that contribute to differential ischemic sensitivity. In addition, gonadal hormone exposure can impact coagulation and fibrinolysis, key factors in the initiation of thrombosis. In this review we will discuss sex differences in stroke, with a focus on platelets, vascular reactivity and coagulation.

Is the Efficacy of Endovascular Treatment for Acute Ischemic Stroke Sex-Related

“…Previously, it was thought that females had higher benefit from intravenous thrombolysis [3], pointing out the role of gonadal hormone exposure on coagulation and fibrinolysis systems as a possible underlying factor [2,3]; however, a recent report by Hametner et al [4] has questioned that idea, showing an equal response in females and males. Regarding endovascular treatment (EVT) of acute ischemic stroke, there is also controversy about the effect of sex [5,6,7].…”

“…The data are somewhat contradictory, some attributing a worse prognosis to females [1]. This difference can result from the longer life expectancy in females and an older age at the time of stroke [2]. …”

The Impact of Gonadal Hormones on the Expression of Human Neurological Disorders

“…Sex steroids may impact atherosclerosis and attendant ischemic stroke by influencing blood coagulation cascades, platelet function, lipid profiles, inflammatory processes within the atheroma and vascular reactivity [25,31]. Estrogen induces hypercoagulability by increasing plasma levels of fibrinogen and clotting factors VII, VIII, IX, X and XII; enhancement of platelet aggregation, and suppression of antithrombin III activity, plasminogen activating inhibitor-1 levels and fibrinolysis.…”

“…Data concerning the effects of estrogens on platelet responses are conflicting. Although the platelets of women exhibit greater reactivity than those of men, hypoestrogenemia may further augment platelet responsiveness and predispose postmenopausal women to ischemic stroke [25]. Estrogen-related hypercoagulability complicating pregnancy, the puerperium and use of hormonal contraceptives may predispose to thromboembolic stroke and cerebral venous infarction.…”

“…Women exhibit ‘spikes' in stroke risk in the peurperium and perimenopausally [25]. Exposure to oral contraceptives has been implicated as an important risk factor in thromboembolic cerebral infarction, cerebral venous thrombosis and subarachnoid hemorrhage.…”