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Prothrombotic disorders in infants and children with cerebral thromboembolism
1Hamilton Civic Hospitals Research Center, McMaster University, Ontario, Canada. deveber@sickkids.on.ca
Insights
A prospective study found 38% of pediatric patients with cerebral thromboembolism had prothrombotic conditions, particularly anticardiolipin antibody. Evaluation for these disorders is recommended for children experiencing stroke or thrombosis.
Area of Science:
- Pediatric Neurology
- Hematology
- Thrombosis Research
Background:
- The role of prothrombotic conditions in pediatric cerebral thromboembolism remains understudied.
- This study prospectively investigates these conditions in a large pediatric cohort.
Purpose of the Study:
- To determine the prevalence of prothrombotic conditions in children diagnosed with arterial ischemic stroke or sinovenous thrombosis.
- To identify specific prothrombotic abnormalities associated with these events in pediatric patients.
Main Methods:
- A cohort of 92 pediatric patients (newborn to 18 years) with cerebral thromboembolism was evaluated.
- Routine testing included assays for plasminogen, antithrombin, protein C, free protein S, activated protein C resistance, anticardiolipin antibody, and lupus anticoagulant.
- Samples were analyzed within two years of the thrombotic event.
Main Results:
- 38% of patients (35/92) exhibited one or more prothrombotic abnormalities.
- Anticardiolipin antibody was the most frequent abnormality (33%), often occurring with other conditions.
- Male sex was a predictor of prothrombotic abnormalities (RR 1.7), while stroke type and age were not.
Conclusions:
- A substantial proportion of children with cerebral thromboembolism present with identifiable prothrombotic conditions.
- Anticardiolipin antibody is a significant finding in this pediatric population.
- Routine screening for prothrombotic disorders is warranted in children diagnosed with cerebral thromboembolism.
Background:
To our knowledge, the contribution of prothrombotic conditions to cerebral thromboembolism has never been prospectively studied in a large series of pediatric patients.
Methods:
The Hospital for Sick Children, Toronto, Ontario, established a program in January 1992 to diagnose and treat children (term newborn to 18 years old) with arterial ischemic stroke or sinovenous thrombosis. The routine evaluation for prothrombotic conditions included plasminogen, antithrombin, protein C, free protein S, activated protein C resistance, IgG and IgM anticardiolipin antibody, and lupus anticoagulant. We analyzed samples taken within 2 years of the event. We report results on patients seen from January 1, 1992, to January 1, 1997.
Results:
Ninety-two patients (47 males and 45 females) entered the program during the study interval. Patients ranged from newborn to 18 years in age. Arterial ischemic stroke occurred in 78% of patients while sinovenous thrombosis occurred in 22%. All were tested for prothrombotic disorders. One or more abnormal results were present in 35 (38%) of the 92 patients. The majority (21/35) had multiple abnormal test results. The abnormal test results were anticardiolipin antibody (33%), plasminogen (9.5%), activated protein C resistance (9%), protein C (7%), antithrombin (12.5%), lupus anticoagulant (8%), and free protein S (11.5%). Male sex predicted the presence of prothrombotic abnormalities (relative risk, 1.7; 95% confidence interval, 1.2-2.5), but stroke type (relative risk, 0.8; 95% confidence interval, 0.7-1.1), age group, and presence of other risk factors did not predict abnormal testing.
Conclusions:
A significant proportion (38%) of children with cerebral thromboembolism had evidence of prothrombotic conditions. In particular, there was a predominance of children with anticardiolipin antibody (33%). These data support a recommendation that children with cerebral thromboembolism be evaluated for prothrombotic disorders.