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Increased fasting total homocysteine plasma levels as a risk factor for thromboembolism in children

Andrea Kosch1, Hans Georg Koch, Achim Heinecke

  • 1Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Germany. koscha@uni-muenster.de

Thrombosis and Haemostasis
|February 13, 2004
PubMed

Insights

Elevated total homocysteine (tHcy) is a risk factor for blood clots in children. Studies show higher tHcy levels in pediatric patients with thromboembolic events, suggesting screening is recommended.

Area of Science:

  • Pediatric Thrombosis
  • Clinical Biochemistry
  • Cardiovascular Research

Background:

  • Elevated total homocysteine (tHcy) is a known risk factor for thromboembolic events in adults.
  • Data on hyperhomocysteinemia in pediatric patients with thromboembolism are limited.
  • This study investigates the association between tHcy levels and thromboembolic events in children.

Purpose of the Study:

  • To determine if elevated fasting total homocysteine (tHcy) levels are associated with an increased risk of thromboembolic events in pediatric patients.
  • To compare tHcy levels in children with a first symptomatic thromboembolic event to those in healthy controls.
  • To establish the clinical significance of hyperhomocysteinemia in childhood thromboembolism.

Main Methods:

  • A case-control study was conducted involving 163 pediatric patients with a first symptomatic thromboembolic event and 255 healthy controls.
  • Participants' ages ranged from 3 months to 18 years.
  • Fasting total homocysteine (tHcy) levels were measured and compared between the patient and control groups, with analysis of age-specific 90th percentiles and odds ratios.

Main Results:

  • Median tHcy levels were significantly higher in pediatric patients with thromboembolism (6.6 micromol/l) compared to healthy controls (5.7 micromol/l) (p<0.0001).
  • 29.5% of patients had tHcy levels above the age-specific 90th percentile, versus 10.2% of controls (OR 2.9).
  • Children in the highest quintile of tHcy had a 4.3 times higher odds of thromboembolic disease compared to those in the lowest quintile, indicating risk even with mild hyperhomocysteinemia.

Conclusions:

  • Hyperhomocysteinemia, even at mild levels above age-specific cut-offs, is a significant risk factor for thromboembolic events in children.
  • Screening for elevated fasting tHcy levels in pediatric patients with thromboembolism is recommended for risk stratification.
  • These findings highlight the importance of assessing tHcy in the pediatric population presenting with thromboembolic conditions.

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