Recurrent Thromboembolism in Infants and Children Suffering From Symptomatic Neonatal Arterial Stroke A Prospective Follow-Up Study

• Published in: Stroke (1970) Vol. 34; no. 12; pp. 2887 - 2892
• Main Authors: Kurnik, Karin, Kosch, Andrea, Sträter, Ronald, Schobess, Rosemarie, Heller, Christine, Nowak-Göttl, Ulrike
• Format: Journal Article
• Language: English
• Published: United States 01.12.2003
• Subjects: Child; Cohort Studies; Comorbidity; Disease-Free Survival; European Continental Ancestry Group - statistics & numerical data; Female; Follow-Up Studies; Germany - epidemiology; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases - diagnosis; Infant, Newborn, Diseases - epidemiology; Infant, Newborn, Diseases - genetics; Intracranial Arterial Diseases - diagnosis; Intracranial Arterial Diseases - epidemiology; Intracranial Arterial Diseases - genetics; Male; Prospective Studies; Recurrence; Risk Factors; Stroke - diagnosis; Stroke - epidemiology; Stroke - genetics; Thromboembolism - diagnosis; Thromboembolism - epidemiology; Thromboembolism - genetics; Germany
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/01.STR.0000103745.03393.39

Background and Purpose— The present study was performed to evaluate the rate of recurrent symptomatic thromboembolism with respect to prothrombotic risk factors and underlying clinical conditions. Methods— In a series of 215 consecutively enrolled neonates with arterial ischemic stroke (AIS), the factor V G1691A mutation, factor II G20210A variant, methylenetetrahydrofolate reductase (MTHFR) T677T genotype, lipoprotein (Lp) (a), antithrombin, protein C, protein S, and anticardiolipin antibodies (ACA) were investigated. Patient median follow-up was 3.5 years (range, 1 to 8 years). Results— During follow-up, 7 infants and children (3.3%) showed recurrent symptomatic thromboembolism (AIS, n=4; venous sinus thrombosis, n=2; deep vein thrombosis of the leg, n=1). The factor V mutation, factor II variant, elevated Lp(a) >30 mg/dL, protein C deficiency, and protein S or antithrombin deficiency were associated with first stroke onset. In 5 of 7 cases (71.4%), prothrombotic risk factors [MTHFR T677T, elevated Lp(a), hyperhomocysteinemia, protein C deficiency] were involved at the time of recurrence. Furthermore, a second thromboembolic event was triggered additionally by underlying diseases (71%), eg, cardiac malformation and immobilization, diarrhea, mastoiditis, and moyamoya syndrome. Conclusions— Data shown here give evidence that symptomatic recurrent thromboembolism is not common in children with neonatal AIS. The risk of a second event, however, is increased when underlying diseases occur and prothrombotic risk factors are involved.