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Thrombin has a well-documented dual role in brain injury: at low concentrations, it is neuroprotective, but at high levels, it is neurotoxic.48,49 Thrombin activity increases significantly within one hour of ICH onset,50 initiating chemokine and adhesion molecule expression, enhancing leukocyte infiltration, activating glial cells,51 and upregulating matrix metalloproteinases (MMP-2 and MMP-9), which degrade extracellular matrix components and compromise BBB integrity.52 Crucially, thrombin and iron interact in a synergistic and pathological manner
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