[Recent advances in cerebrovascular diseases from the view point of blood coagulation/fibrinolysis]

Cerebrovascular diseases (CVD) are one of the most serious clinical problem in Japan. Here we review patho-mechanism, prevention and treatment of CVD, from the view point of blood coagulation/fibrinolysis and platelets. The hemostatic system is quite unique in the brain. One of the characteristic functional and structural basis of circulation is decreased expression of thromobomodulin, an anticoagulant endothelial protein in the brain. This may cause thrombotic tendency in the brain compared to other organs. Another characteristics is rich in tissue factor in the brain. Thus once vascular vessels are injured, circulatory factor VII may interact with the tissue factor and result activation of extrinsic coagulation pathway. Generated thrombin could not be regulated efficiently like other organs, because of decreased expression of thrombomodulin.