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Review
. 2014 Sep:259:16-27.
doi: 10.1016/j.expneurol.2014.02.011. Epub 2014 Feb 19.

Sex differences in stroke: the contribution of coagulation

Meaghan Roy-O'Reilly  1 , Louise D McCullough  2
Affiliations
Review

Sex differences in stroke: the contribution of coagulation

Meaghan Roy-O'Reilly et al. Exp Neurol. 2014 Sep.

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.

Keywords: Cerebral ischemia; Estrogen; Thrombosis; Vasculature; Women.

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Figures

Figure 1
Figure 1. Cerebral Vasodilatory Estrogen Effects
Sex differences in the regulation of cerebral vasculature have been described. Prolonged exposure to estrogen promotes cerebral vasodilation by increasing vasodilatory factors and suppression of vasoconstriction mechanisms; these effects are mediated via both genomic and non-genomic pathways.
Figure 2
Figure 2. Simplified schematic of significant effects of estrogen on coagulation
Estrogen influences the levels of many clotting factors via gene transcription, increasing the likelihood of clotting and related complications, including stroke. The most significant increase involves factor VII of the extrinsic coagulation cascade. While reduction in FVII results in excessive bleeding, reduction of FXII, another estrogen-increased clotting factor does not appear to have the same bleeding risks and may prove a novel target for stroke prevention, particularly in women.
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