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Biomarkers of hypercoagulability and inflammation in childhood-onset arterial ischemic stroke

Timothy J Bernard1, Laura Z Fenton, Susan D Apkon

  • 1Department of Pediatrics, Section of Child Neurology, Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado Denver and The Children's Hospital, Aurora, CO 80045-0507, USA. timothy.bernard@ucdenver.edu

The Journal of Pediatrics
|December 22, 2009
PubMed

Insights

Biomarkers like D-dimer and C-reactive protein (CRP) are often elevated in children with arterial ischemic stroke (AIS). Elevated D-dimer levels may indicate a cardioembolic cause in pediatric AIS.

Area of Science:

  • Pediatric Neurology
  • Vascular Neurology
  • Biomarker Discovery

Background:

  • Arterial ischemic stroke (AIS) in children is a significant cause of long-term disability.
  • Understanding the underlying pathophysiology and identifying risk factors for recurrence are crucial in pediatric AIS.
  • Hypercoagulability and inflammation are suspected contributors to AIS in children.

Purpose of the Study:

  • To investigate the prevalence of hypercoagulability and inflammation biomarkers in acute childhood-onset AIS.
  • To determine if these biomarkers differ among specific etiologic subtypes of pediatric AIS.
  • To assess the utility of D-dimer in identifying cardioembolic AIS in children.

Main Methods:

  • Prospective/retrospective cohort study of 50 children with acute AIS (2005-2009).
  • Serial evaluation of D-dimer, factor VIII (FVIII) activity, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
  • Classification of patients by stroke subtype: cardioembolic, moyamoya, non-moyamoya arteriopathy, or other.

Main Results:

  • D-dimer and CRP were frequently elevated in acute childhood AIS, decreasing over time.
  • Acute D-dimer levels were significantly higher in cardioembolic AIS compared to noncardioembolic AIS (P = .002).
  • D-dimer > or = 0.50 microg/mL showed 78% sensitivity and 79% specificity for cardioembolic AIS.

Conclusions:

  • D-dimer and CRP are potential biomarkers for determining the cause and predicting the outcome of childhood AIS.
  • Further research is warranted to explore the role of these and other biomarkers in pediatric AIS.
  • These findings contribute to understanding the inflammatory and hypercoagulable states associated with pediatric stroke.
Abstract

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