Sex Differences in Hemostatic Factors in Patients With Ischemic Stroke and the Relation With Migraine—A Systematic Review

Abstract

Background: Women are more affected by stroke than men. This might, in part, be explained by sex differences in stroke pathophysiology. The hemostasis system is influenced by sex hormones and associated with female risk factors for stroke, such as migraine.Aim: To systematically review possible sex differences in hemostatic related factors in patients with ischemic stroke in general, and the influence of migraine on these factors in women with ischemic stroke.Results: We included 24 studies with data on sex differences of hemostatic factors in 7247 patients with ischemic stroke (mean age 57–72 years, 27–57% women) and 25 hemostatic related factors. Levels of several factors were higher in women compared with men; FVII:C (116% ± 30% vs. 104% ± 30%), FXI (0.14 UI/mL higher in women), PAI-1 (125.35 ± 49.37 vs. 96.67 ± 38.90 ng/mL), D-dimer (1.25 ± 0.31 vs. 0.95 ± 0.24 μg/mL), and aPS (18.7% vs. 12.0% positive). In contrast, protein-S (86.2% ± 23.0% vs. 104.7% ± 19.8% antigen) and P-selectin (48.9 ± 14.4 vs. 79.1 ± 66.7 pg/mL) were higher in men. Most factors were investigated in single studies, at different time points after stroke, and in different stroke subtypes. Only one small study reported data on migraine and hemostatic factors in women with ischemic stroke. No differences in fibrinogen, D-dimer, t-PA, and PAI-1 levels were found between women with and without migraine.Conclusion: Our systematic review suggests that sex differences exist in the activation of the hemostatic system in ischemic stroke. Women seem to lean more toward increased levels of procoagulant factors whereas men exhibit increased levels of coagulation inhibitors. To obtain better insight in sex-related differences in hemostatic factors, additional studies are needed to confirm these findings with special attention for different stroke phases, stroke subtypes, and not in the least women specific risk factors, such as migraine.

The Non-Activated Thromboelastometry (NATEM) Assay’s Application among Adults and Neonatal/Pediatric Population: A Systematic Review

“…Sulaj et al [32] reported reference ranges for NATEM parameters in healthy-term neonates using cord blood samples and showed that the gestational age had a positive correlation with lysis index at 30 and 60 min; these results are in accordance with other studies performed in healthy neonates using intrinsically activated test with ellagic acid (INTEM) and extrinsically activated test with tissue factor (EXTEM) assays [43,44]. Moreover, female neonates appear to have a more hypercoagulable profile compared to males, manifested with faster CT and higher clot amplitude at 20 min (A20) and MCF; a finding which can attributed to the increased levels of coagulation factors that females present [45].…”

Risk of Stroke in Migrainous Women, a Hidden Association: A Systematic Review

“…A stroke may occur when there's an obstruction of blood flow and oxygen to the brain and could be due to a blockage in a blood vessel or if a vessel ruptures [ 16 ]. In addition, different types of strokes exist; one of them is ischemic stroke, which is the most common type, and the other one is hemorrhagic stroke, the less common type [ 17 ].…”

“…As a result, the symptoms of a stroke may differ depending on the location. Moreover, the signs of a stroke can include sudden loss of balance, sudden loss of vision, facial weakness, arm weakness, and altered speech [ 16 ]. Table 4 outlines the main signs and symptoms of a stroke, and they can be remembered by the mnemonic BE FAST [ 18 ].…”

“…A possible link between these two conditions can prove to be a substantial burden on society [ 15 ]. A morbid outcome could occur if a hemorrhagic stroke or ischemic stroke with migraine were misdiagnosed as migraine with aura [ 16 , 17 ]. Few studies have addressed the reasons for an association between migraine and stroke; however, the exact mechanism as to why there is a relationship is still not fully understood [ 18 ].…”

Short-Term Prognostic Predictive Evaluation in Female Patients With Ischemic Stroke: A Retrospective Cross-Sectional Study

“…The incidence of stroke is higher in childhood and early adulthood for men ( 3 ). Stroke rates increase in women in middle age due to hormonal factors ( 4 ). The incidence of stroke in advanced age exceeds that of men ( 3 ).…”