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 inBlood Vol. 112; no. 9; pp. 3555 - 3562
Main Authors Stoll, Guido, Kleinschnitz, Christoph, Nieswandt, Bernhard
Format Journal Article
LanguageEnglish
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.
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
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  surname: Stoll
  fullname: Stoll, Guido
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  organization: Department of Neurology, University of Würzburg, Würzburg, Germany
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  givenname: Christoph
  surname: Kleinschnitz
  fullname: Kleinschnitz, Christoph
  organization: Department of Neurology, University of Würzburg, Würzburg, Germany
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  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
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Issue 9
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
Language English
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CC BY 4.0
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Americain Society of Hematology
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  article-title: Multimodal therapy for the treatment of severe ischemic stroke combining GPIIb/IIIa antagonists and angioplasty after failure of thrombolysis.
  publication-title: Stroke
  doi: 10.1161/01.STR.0000179043.73314.4f
  contributor:
    fullname: Abou-Chebl
– volume: 37
  start-page: 419
  year: 2006
  ident: 2019111720345484300_B10
  article-title: Endovascular recanalization therapy in acute ischemic stroke.
  publication-title: Stroke
  doi: 10.1161/01.STR.0000198808.90579.65
  contributor:
    fullname: Choi
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Snippet In ischemic stroke, treatment options are limited. Therapeutic thrombolysis is restricted to the first few hours after stroke, and the utility of current...
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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
URI https://dx.doi.org/10.1182/blood-2008-04-144758
https://www.ncbi.nlm.nih.gov/pubmed/18676880
https://search.proquest.com/docview/69702713
Volume 112
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