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Published on: August 18, 2015
Cerebral venous thrombosis in children: a multifactorial origin
Christine Heller1, Achim Heinecke, Ralf Junker
1Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main, Germany.
Insights
Cerebral venous thrombosis (CVT) in children is often multifactorial. A combination of prothrombotic risk factors and underlying conditions significantly increases the risk of CVT in pediatric patients.
Area of Science:
- Pediatric Thrombosis
- Vascular Neurology
- Hematology
Background:
- Cerebral venous thrombosis (CVT) in children is a rare but serious condition.
- Identifying risk factors is crucial for prevention and management.
Purpose of the Study:
- To investigate the association between prothrombotic risk factors and underlying conditions with CVT in children.
- To determine the independent predictors of CVT in a pediatric cohort.
Main Methods:
- A case-control study involving 149 pediatric patients with CVT and 149 matched controls.
- Analysis of genetic factors (Factor V G1691A, Factor II G20210A), lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies.
- Assessment of underlying clinical conditions such as infections, malignancies, and autoimmune diseases.
Main Results:
- 56.4% of CVT patients had at least one prothrombotic risk factor compared to 20.8% of controls.
- 70.5% of CVT patients had an underlying predisposing condition.
- Multivariate analysis revealed independent associations for increased Lp(a), protein C deficiency, and the combination of a prothrombotic risk factor with an underlying condition.
Conclusions:
- CVT in children is a multifactorial disease.
- The interplay between prothrombotic risk factors and underlying conditions is key in the majority of pediatric CVT cases.
- Early identification of these combined factors is essential for clinical practice.
Background:
The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use of prothrombotic drugs) with cerebral venous thrombosis (CVT) in children.
Methods And Results:
From 1995 to 2002, 149 pediatric patients aged newborn to <18 years (median 6 years) with CVT were consecutively enrolled. In patients and in 149 age- and gender-matched children with similar underlying clinical conditions but without CVT, the factor V G1691A mutation, the factor II G20210A variant, lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies, as well as associated clinical conditions, were investigated. Eighty-four (56.4%) of the patients had at least 1 prothrombotic risk factor compared with 31 control children (20.8%; P<0.0001). In addition, 105 (70.5%) of 149 patients with CVT presented with an underlying predisposing condition. On univariate analysis, factor V, protein C, protein S, and elevated Lp(a) were found to be significantly associated with CVT. However, in multivariate analysis, only the combination of a prothrombotic risk factor with an underlying condition (OR 3.9, 95% CI 1.8 to 8.6), increased Lp(a) (OR 4.1, 95% CI 2.0 to 8.7), and protein C deficiency (OR 11.1, 95% CI 1.2 to 104.4) had independent associations with CVT in the children investigated.
Conclusions:
CVT in children is a multifactorial disease that, in the majority of cases, results from a combination of prothrombotic risk factors and/or underlying clinical condition.
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