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Wolfgang Miesbach: Infections as a Trigger for Stroke in Young Adults
Wolfgang Miesbach/LinkedIn
Mar 24, 2026, 16:21

Wolfgang Miesbach: Infections as a Trigger for Stroke in Young Adults

Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared a post on LinkedIn about a recent article by Barbara M. Hulsen et al, published in Stroke:

”Infections as a Trigger for Stroke in Young Adults – The role of thromboinflammation.

Just published in Stroke, this multicenter study by Hulsen et al. sheds new light on why young people — without classic cardiovascular risk factors — suffer from cryptogenic ischemic stroke (CIS).

  • The question: Can a preceding infection act as a transient trigger for early-onset CIS (ages 18–49), and do coagulation biomarkers explain the mechanism?
  • The SECRETO study enrolled 537 matched case-control pairs across 19 European centers (2013–2022), measuring coagulation biomarkers — VWF, FVIII, fibrinogen, antithrombin III, and protein C — at baseline and 3-month follow-up.

What they found:

  • Infection in the preceding week – 2.6-fold higher odds of CIS (OR 2.64; 95% CI 1.34–5.20)
  • VWF was markedly elevated in CIS patients with recent infection (157 IU/mL) vs. those without (121 IU/mL) — but not in healthy controls, suggesting a heightened thromboinflammatory sensitivity in CIS patients
  • Each SD increase in VWF and FVIII was linked to higher stroke odds in those with recent infection or fever

A ‘second hit’ hypothesis:

Importantly, CIS patients already showed higher baseline levels of VWF, FVIII, and fibrinogen compared to healthy controls — even without a recent infection.

Why thromboinflammation can lead to stroke:

The central role of VWF and platelet recruitment under high shear flow conditions in cerebral vessels points specifically to arterial thrombosis.

The paper explicitly cites the VWF–platelet glycoprotein Ib axis as a key thromboinflammatory driver specifically in stroke.”

Title: Preceding Infections and Coagulation Biomarkers in Early-Onset Cryptogenic Ischemic Stroke

Authors: Barbara M. Hulsen, Janneke P. Spiegelenberg, Nicolas Martinez-Majander, Lauri Tulkki, Tomi Sarkanen, Pekka Jäkälä, Petra Redfors, Juha Huhtakangas, Pauli Ylikotila, Bettina von Sarnowski, Nilufer Yesilot, Ulrike Waje-Andreassen, Ana Catarina Fonseca, Patricia Martínez-Sánchez, Janika Kõrv, Phillip Ferdinand, Kristina Ryliskiene, Alessandro Pezzini, Radim Licenik, Marialuisa Zedde, Juha Sinisalo, Eva Gerdts, Tuukka A. Helin, Lotta Joutsi-Korhonen, Tímea Szántó, Frederick Palm, Armin J. Grau, Frank-Erik de Leeuw, Jukka Putaala

Read the Full Article on Stroke

Wolfgang Miesbach: Infections as a Trigger for Stroke in Young Adults

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Alessandro Pezzini Ana Catarina Fonseca Armin J. Grau Barbara M. Hulsen Bettina von Sarnowski Eva Gerdts Frank-Erik de Leeuw Frederick Palm Health Hematology Hemostasis Hemostasis News Hemostasis Today infections Janika Kõrv Janneke P. Spiegelenberg Juha Huhtakangas Juha Sinisalo Jukka Putaala Kristina Ryliskiene Lauri Tulkki Lotta Joutsi-Korhonen Marialuisa Zedde Medicine Nicolas Martinez-Majander Nilufer Yesilot Patricia Martínez-Sánchez Pauli Ylikotila Pekka Jäkälä Petra Redfors Phillip Ferdinand Platelet Radim Licenik SECRETO stroke thromboinflammation thrombosis Tímea Szántó Tomi Sarkanen Tuukka A. Helin Ulrike Waje-Andreassen VWF Young Adults
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