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Sex-Based Differences in Thrombus Composition in Acute Ischemic Stroke.

Ghil Schwarz1, Angelo Cascio Rizzo1, Amedeo Cervo2

  • 1Department of Neurology and Stroke Unit ASST Grande Ospedale Metropolitano Niguarda Milan Italy.

Stroke (Hoboken, N.J.)
|January 23, 2026
PubMed
Summary
This summary is machine-generated.

Sex independently impacts white blood cell (WBC) percentages in acute ischemic stroke thrombi. Fibrin and red blood cell (RBC) composition differences between sexes may be linked to RBC count, not sex itself.

Keywords:
acute ischemic strokeendovascular thrombectomysex‐based differencesthrombus composition

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Area of Science:

  • Neurology
  • Pathology
  • Biomedical Engineering

Background:

  • Endovascular thrombectomy enables detailed analysis of thrombus composition in acute ischemic stroke.
  • Thrombus composition variations can influence patient outcomes.
  • Recognized differences in coagulation physiology between sexes warrant investigation into sex-based thrombus composition variations.

Purpose of the Study:

  • To investigate potential sex-based differences in the histological composition of thrombi from patients with acute ischemic stroke.
  • To determine if sex is an independent predictor of thrombus composition.

Main Methods:

  • Retrospective analysis of 73 patients undergoing endovascular thrombectomy for acute ischemic stroke.
  • Thrombi were stained (hematoxylin and eosin) to quantify percentages of fibrin, red blood cells (RBCs), and white blood cells (WBCs).
  • Univariate and multivariate analyses were performed, adjusting for relevant variables.

Main Results:

  • Male patients had higher RBC percentages (51.5%) compared to females (33.8%).
  • Female patients exhibited higher fibrin (58.3%) and WBC (6.5%) percentages than males (45.1% and 4.4%, respectively).
  • Multivariate analysis revealed sex as an independent predictor only for WBC percentage, while RBC count independently predicted fibrin and RBC percentages.

Conclusions:

  • Sex is an independent determinant of white blood cell (WBC) percentage in acute ischemic stroke thrombi.
  • Independent associations between sex and fibrin or red blood cell (RBC) percentages were not found, suggesting mediation by RBC count.
  • Future research should incorporate sex and baseline laboratory values when studying thrombus composition.