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.