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Prothrombotic risk factors in the evaluation and management of perinatal stroke

Eric F Grabowski1, Ferdinando S Buonanno, Kalpathy Krishnamoorthy

  • 1Department of Pediatrics (Hematology/Oncology), Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Grabowski.Eric@MGH.Harvard.edu

Seminars in Perinatology
|September 11, 2007
PubMed

Insights

Plasma-phase risk factors like factor V Leiden are key in perinatal stroke pathogenesis for children. Anticoagulation may benefit a small percentage of children to prevent recurrent strokes.

Area of Science:

  • Pediatric Neurology
  • Hematology
  • Genetics

Background:

  • Perinatal stroke pathogenesis was traditionally attributed to non-hematologic maternal and perinatal factors.
  • Emerging evidence highlights the role of plasma-phase risk factors in pediatric stroke.

Purpose of the Study:

  • To investigate the role of plasma-phase risk factors in the pathogenesis of perinatal stroke in children.
  • To evaluate the risk of stroke recurrence and the potential benefit of anticoagulation therapy.

Main Methods:

  • Review of clinical studies and follow-up data on children with perinatal stroke.
  • Analysis of plasma-phase risk factors including factor V Leiden, elevated lipoprotein (a), and MTHFR mutations.
  • Assessment of stroke recurrence rates and association with identified risk factors.

Main Results:

  • Plasma-phase risk factors are implicated in the pathogenesis of perinatal stroke.
  • The overall risk of stroke recurrence is low (approximately 2%).
  • Recurrent strokes are associated with the presence of plasma-phase risk factors in affected children.

Conclusions:

  • A subset of children with perinatal stroke may benefit from anticoagulation to prevent recurrence and other thrombotic events.
  • Management of maternal systemic disorders is crucial for subsequent pregnancies.
  • Identifying plasma-phase risk factors is important for personalized treatment strategies in pediatric stroke.

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