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May 30, 2018Thrombosis and HaemostasisOpen Access

Targeting von Willebrand Factor in Ischaemic Stroke: Focus on Clinical Evidence

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Key result

Targeting von Willebrand factor appears promising for secondary prevention of ischaemic stroke recurrence, particularly in patients with large artery atherosclerosis.

Why the study?

Does therapeutic inhibition of von Willebrand factor prevent ischaemic stroke in patients at risk?

Population

Patients at risk for first or recurrent ischaemic stroke

Design

Review

Authors

NBNina BuchteleUniversitätszahnklinik WienMSMichael SchwameisUniversitätszahnklinik WienJGJames C. GilbertAccent Therapeutics (United States)

Discussion

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Implication

Supports vWF inhibition trials for secondary stroke prevention in large artery atherosclerosis; leaves open efficacy and safety in randomized data.

Structured PICO

Does therapeutic inhibition of von Willebrand factor prevent ischaemic stroke in patients at risk?

P
Population
Patients at risk for first or recurrent ischaemic stroke
I
Intervention
Therapeutic inhibition of von Willebrand factor (vWF)
O
Outcome
Ischaemic stroke, stroke recurrence, or stroke-associated mortalityhard clinical

Elevated vWF levels and decreased ADAMTS13 activity are strongly associated with increased risk of ischaemic stroke, highlighting the GPIb-vWF axis as a promising therapeutic target for stroke prevention.

Limitations

  • Observational studies cannot establish a cause-effect relationship between elevated vWF levels and stroke.
  • Translation of results from murine models into humans is limited.
  • Direct empirical evidence for anti-platelet non-responsiveness in stroke recurrence is generally scarce.
  • Results from murine models may not fully translate to humans as wild-type mice are relatively resistant to atherosclerosis
  • Observational and case-control studies cannot establish a cause-effect relationship to determine if elevated vWF is a cause or consequence of acute ischaemia

Cite This Study

Buchtele et al. (2018) conducted a review in Ischaemic Stroke. von Willebrand Factor (vWF) inhibitors was evaluated. Targeting von Willebrand factor appears promising for secondary prevention of ischaemic stroke recurrence, particularly in patients with large artery atherosclerosis.

synapsesocial.com/papers/6a10e7bb2c0ee39daeee4df1https://doi.org/10.1055/s-0038-1648251
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.1993 · 12,478 citations
  2. 2Effect of Combined Aspirin and Extended-Release Dipyridamole Versus Clopidogrel on Functional Outcome and Recurrence in Acute, Mild Ischemic Stroke2010 · 58 citations
  3. 3Intimal Deposition of Functional von Willebrand Factor in Atherogenesis1999 · 67 citations
  4. 4Recombinant ADAMTS-13: first-in-human pharmacokinetics and safety in congenital thrombotic thrombocytopenic purpura2017 · 265 citations