Molecular mechanisms of thrombus formation in ischemic stroke: novel insights and targets for treatment
In ischemic stroke, treatment options are limited. Therapeutic thrombolysis is restricted to the first few hours after stroke, and the utility of current platelet aggregation inhibitors, including GPIIb/IIIa receptor antagonists, and anticoagulants is counterbalanced by the risk of intracerebral ble...
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Published in | Blood Vol. 112; no. 9; pp. 3555 - 3562 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Washington, DC
Elsevier Inc
01.11.2008
Americain Society of Hematology |
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Abstract | In ischemic stroke, treatment options are limited. Therapeutic thrombolysis is restricted to the first few hours after stroke, and the utility of current platelet aggregation inhibitors, including GPIIb/IIIa receptor antagonists, and anticoagulants is counterbalanced by the risk of intracerebral bleeding complications. Numerous attempts to establish neuroprotection in ischemic stroke have been unfruitful. Thus, there is strong demand for novel treatment strategies. Major advances have been made in understanding the molecular functions of platelet receptors such as glycoprotein Ib (GPIb) and GPVI and their downstream signaling pathways that allow interference with their function. Inhibition of these receptors in the mouse stroke model of transient middle cerebral artery occlusion prevented infarctions without increasing the risk of intracerebral bleeding. Similarly, it is now clear that the intrinsic coagulation factor XII (FXII) and FXI play a functional role in thrombus formation and stabilization during stroke: their deficiency or blockade protects from cerebral ischemia without overtly affecting hemostasis. Based on the accumulating evidence that thrombus formation and hemostasis are not inevitably linked, new concepts for prevention and treatment of ischemic stroke may eventually emerge without the hazard of severe bleeding complications. This review discusses recent advances related to antithrombotic strategies in experimental stroke research. |
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AbstractList | In ischemic stroke, treatment options are limited. Therapeutic thrombolysis is restricted to the first few hours after stroke, and the utility of current platelet aggregation inhibitors, including GPIIb/IIIa receptor antagonists, and anticoagulants is counterbalanced by the risk of intracerebral bleeding complications. Numerous attempts to establish neuroprotection in ischemic stroke have been unfruitful. Thus, there is strong demand for novel treatment strategies. Major advances have been made in understanding the molecular functions of platelet receptors such as glycoprotein Ib (GPIb) and GPVI and their downstream signaling pathways that allow interference with their function. Inhibition of these receptors in the mouse stroke model of transient middle cerebral artery occlusion prevented infarctions without increasing the risk of intracerebral bleeding. Similarly, it is now clear that the intrinsic coagulation factor XII (FXII) and FXI play a functional role in thrombus formation and stabilization during stroke: their deficiency or blockade protects from cerebral ischemia without overtly affecting hemostasis. Based on the accumulating evidence that thrombus formation and hemostasis are not inevitably linked, new concepts for prevention and treatment of ischemic stroke may eventually emerge without the hazard of severe bleeding complications. This review discusses recent advances related to antithrombotic strategies in experimental stroke research. |
Author | Kleinschnitz, Christoph Nieswandt, Bernhard Stoll, Guido |
Author_xml | – sequence: 1 givenname: Guido surname: Stoll fullname: Stoll, Guido email: stoll_g@klinik.uni-wuerzburg.de organization: Department of Neurology, University of Würzburg, Würzburg, Germany – sequence: 2 givenname: Christoph surname: Kleinschnitz fullname: Kleinschnitz, Christoph organization: Department of Neurology, University of Würzburg, Würzburg, Germany – sequence: 3 givenname: Bernhard surname: Nieswandt fullname: Nieswandt, Bernhard email: bernhard.nieswandt@virchow.uni-wuerzburg.de organization: Rudolf Virchow Center, Deutsche Forschungsgemeinschaft (DFG) Research Center for Experimental Biomedicine, University of Würzburg, Würzburg, Germany |
BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20804485$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/18676880$$D View this record in MEDLINE/PubMed |
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Keywords | Cerebral infarction Nervous system diseases Stroke Hematology Targeted therapy Thrombus Cardiovascular disease Mechanism Cerebral disorder Vascular disease Central nervous system disease Brain ischemia Cerebrovascular disease |
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SubjectTerms | Animals Anticoagulants - therapeutic use Biological and medical sciences Blood Coagulation Blood Platelets - physiology Brain Ischemia - complications Brain Ischemia - physiopathology Brain Ischemia - therapy Disease Models, Animal Hematologic and hematopoietic diseases Humans Intracranial Thrombosis - complications Intracranial Thrombosis - physiopathology Intracranial Thrombosis - therapy Medical sciences Neurology Platelet Aggregation Inhibitors - therapeutic use Platelet Membrane Glycoproteins - physiology Stroke - etiology Stroke - physiopathology Stroke - prevention & control Stroke - therapy Thrombolytic Therapy Vascular diseases and vascular malformations of the nervous system |
Title | Molecular mechanisms of thrombus formation in ischemic stroke: novel insights and targets for treatment |
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