Hemostasis and Stroke

Stroke is the leading cause of death and permanent disability worldwide. Hemostasis abnormalities resulting in thrombosis of the cerebral vasculature lead to ischemic strokes, while unbalanced hemostasis resulting in bleeding is a key contributor to most hemorrhagic strokes. Despite best efforts to study the hemostatic system, specific alterations that predispose patients to stroke remain poorly defined, and the exact role played by hemostasis in the pathogenesis of stroke remains controversial. Nevertheless, a growing body of evidence indicates that hemostasis biomarkers could be useful when assessing the pathology of thrombus formation, subtype diagnosis and prognosis in the acute phase of a cerebral event. In the past years, studies on the composition of thrombi extracted via endovascular thrombectomy provided useful insights to ischemic stroke pathomechanisms and treatment failure. In addition to intravascular hemostasis, the brain is a unique organ that expresses a local hemostasis regulatory system. This is mostly derived from brain microvascular cells (astrocytes, pericytes) and the endothelium, and may play a crucial role in ischemic or hemorrhagic stroke pathology.

Better understanding of the alterations of the hemostatic system, particularly its counter play with inflammation and vascular biology, could lead to the discovery of biomarkers with prognostic value on stroke risk and therapy outcomes. Recent advances in biomarker research point to promising results that need to be further investigated and validated in large patient populations. Investigation of the hemostatic system in patients with strokes of various type, location and severity may help to identify specific risk factors of stroke. The ability to predict the clinical outcomes of stroke may help to select the most appropriate treatment options that could ultimately lead to individualized patient care. Novel fibrinolytic agents and novel delivery strategies might provide safer and more effective alternatives to currently used thrombolysis. Studies on thrombus composition could provide insights into pathomechanisms leading to treatment failure. Understanding local hemostatic mechanisms of the brain may provide a new approach for prediction, prevention and treatment of thrombotic or hemorrhagic brain damage.

The aim of this Research Topic is to present and discuss recent advances on hemostasis, thrombosis or vascular biology related to all areas of stroke research. Topics include but are not limited to:

• Hemostasis alterations or biomarkers predicting stroke risk, prognosis and recurrence
• Hemostasis studies related to stroke pathophysiology, including translational studies
• Stroke thrombus composition, thrombus structure analysis
• Advances on improving thrombolysis or endovascular thrombectomy outcomes and safety
• Novel hemostasis therapies or strategies to improve acute or chronic stroke care
• Novel fibrinolytic or reperfusion agents
• Fibrinolysis mathematical models
• Brain hemostasis, regulation and function

Submissions of original research articles or review papers are solicited to this Research Topic. Submissions of basic scientific, translational, or clinical papers contributing to the advances in this field are equally welcome.