Cerebral Venous Thrombosis in Children A Multifactorial Origin
Background— The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use...
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| Published in | Circulation (New York, N.Y.) Vol. 108; no. 11; pp. 1362 - 1367 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hagerstown, MD
Lippincott Williams & Wilkins
16.09.2003
American Heart Association, Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-7322 1524-4539 1524-4539 |
| DOI | 10.1161/01.CIR.0000087598.05977.45 |
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| Abstract | Background—
The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use of prothrombotic drugs) with cerebral venous thrombosis (CVT) in children.
Methods and Results—
From 1995 to 2002, 149 pediatric patients aged newborn to <18 years (median 6 years) with CVT were consecutively enrolled. In patients and in 149 age- and gender-matched children with similar underlying clinical conditions but without CVT, the factor V G1691A mutation, the factor II G20210A variant, lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies, as well as associated clinical conditions, were investigated. Eighty-four (56.4%) of the patients had at least 1 prothrombotic risk factor compared with 31 control children (20.8%;
P
<0.0001). In addition, 105 (70.5%) of 149 patients with CVT presented with an underlying predisposing condition. On univariate analysis, factor V, protein C, protein S, and elevated Lp(a) were found to be significantly associated with CVT. However, in multivariate analysis, only the combination of a prothrombotic risk factor with an underlying condition (OR 3.9, 95% CI 1.8 to 8.6), increased Lp(a) (OR 4.1, 95% CI 2.0 to 8.7), and protein C deficiency (OR 11.1, 95% CI 1.2 to 104.4) had independent associations with CVT in the children investigated.
Conclusions—
CVT in children is a multifactorial disease that, in the majority of cases, results from a combination of prothrombotic risk factors and/or underlying clinical condition. |
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| AbstractList | The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use of prothrombotic drugs) with cerebral venous thrombosis (CVT) in children.
From 1995 to 2002, 149 pediatric patients aged newborn to <18 years (median 6 years) with CVT were consecutively enrolled. In patients and in 149 age- and gender-matched children with similar underlying clinical conditions but without CVT, the factor V G1691A mutation, the factor II G20210A variant, lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies, as well as associated clinical conditions, were investigated. Eighty-four (56.4%) of the patients had at least 1 prothrombotic risk factor compared with 31 control children (20.8%; P<0.0001). In addition, 105 (70.5%) of 149 patients with CVT presented with an underlying predisposing condition. On univariate analysis, factor V, protein C, protein S, and elevated Lp(a) were found to be significantly associated with CVT. However, in multivariate analysis, only the combination of a prothrombotic risk factor with an underlying condition (OR 3.9, 95% CI 1.8 to 8.6), increased Lp(a) (OR 4.1, 95% CI 2.0 to 8.7), and protein C deficiency (OR 11.1, 95% CI 1.2 to 104.4) had independent associations with CVT in the children investigated.
CVT in children is a multifactorial disease that, in the majority of cases, results from a combination of prothrombotic risk factors and/or underlying clinical condition. BACKGROUND: The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use of prothrombotic drugs) with cerebral venous thrombosis (CVT) in children. METHODS AND RESULTS: From 1995 to 2002, 149 pediatric patients aged newborn to <18 years (median 6 years) with CVT were consecutively enrolled. In patients and in 149 age- and gender-matched children with similar underlying clinical conditions but without CVT, the factor V G1691A mutation, the factor II G20210A variant, lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies, as well as associated clinical conditions, were investigated. Eighty-four (56.4%) of the patients had at least 1 prothrombotic risk factor compared with 31 control children (20.8%; P<0.0001). In addition, 105 (70.5%) of 149 patients with CVT presented with an underlying predisposing condition. On univariate analysis, factor V, protein C, protein S, and elevated Lp(a) were found to be significantly associated with CVT. However, in multivariate analysis, only the combination of a prothrombotic risk factor with an underlying condition (OR 3.9, 95% CI 1.8 to 8.6), increased Lp(a) (OR 4.1, 95% CI 2.0 to 8.7), and protein C deficiency (OR 11.1, 95% CI 1.2 to 104.4) had independent associations with CVT in the children investigated. CONCLUSIONS: CVT in children is a multifactorial disease that, in the majority of cases, results from a combination of prothrombotic risk factors and/or underlying clinical condition. The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use of prothrombotic drugs) with cerebral venous thrombosis (CVT) in children.BACKGROUNDThe present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use of prothrombotic drugs) with cerebral venous thrombosis (CVT) in children.From 1995 to 2002, 149 pediatric patients aged newborn to <18 years (median 6 years) with CVT were consecutively enrolled. In patients and in 149 age- and gender-matched children with similar underlying clinical conditions but without CVT, the factor V G1691A mutation, the factor II G20210A variant, lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies, as well as associated clinical conditions, were investigated. Eighty-four (56.4%) of the patients had at least 1 prothrombotic risk factor compared with 31 control children (20.8%; P<0.0001). In addition, 105 (70.5%) of 149 patients with CVT presented with an underlying predisposing condition. On univariate analysis, factor V, protein C, protein S, and elevated Lp(a) were found to be significantly associated with CVT. However, in multivariate analysis, only the combination of a prothrombotic risk factor with an underlying condition (OR 3.9, 95% CI 1.8 to 8.6), increased Lp(a) (OR 4.1, 95% CI 2.0 to 8.7), and protein C deficiency (OR 11.1, 95% CI 1.2 to 104.4) had independent associations with CVT in the children investigated.METHODS AND RESULTSFrom 1995 to 2002, 149 pediatric patients aged newborn to <18 years (median 6 years) with CVT were consecutively enrolled. In patients and in 149 age- and gender-matched children with similar underlying clinical conditions but without CVT, the factor V G1691A mutation, the factor II G20210A variant, lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies, as well as associated clinical conditions, were investigated. Eighty-four (56.4%) of the patients had at least 1 prothrombotic risk factor compared with 31 control children (20.8%; P<0.0001). In addition, 105 (70.5%) of 149 patients with CVT presented with an underlying predisposing condition. On univariate analysis, factor V, protein C, protein S, and elevated Lp(a) were found to be significantly associated with CVT. However, in multivariate analysis, only the combination of a prothrombotic risk factor with an underlying condition (OR 3.9, 95% CI 1.8 to 8.6), increased Lp(a) (OR 4.1, 95% CI 2.0 to 8.7), and protein C deficiency (OR 11.1, 95% CI 1.2 to 104.4) had independent associations with CVT in the children investigated.CVT in children is a multifactorial disease that, in the majority of cases, results from a combination of prothrombotic risk factors and/or underlying clinical condition.CONCLUSIONSCVT in children is a multifactorial disease that, in the majority of cases, results from a combination of prothrombotic risk factors and/or underlying clinical condition. Background— The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use of prothrombotic drugs) with cerebral venous thrombosis (CVT) in children. Methods and Results— From 1995 to 2002, 149 pediatric patients aged newborn to <18 years (median 6 years) with CVT were consecutively enrolled. In patients and in 149 age- and gender-matched children with similar underlying clinical conditions but without CVT, the factor V G1691A mutation, the factor II G20210A variant, lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies, as well as associated clinical conditions, were investigated. Eighty-four (56.4%) of the patients had at least 1 prothrombotic risk factor compared with 31 control children (20.8%; P <0.0001). In addition, 105 (70.5%) of 149 patients with CVT presented with an underlying predisposing condition. On univariate analysis, factor V, protein C, protein S, and elevated Lp(a) were found to be significantly associated with CVT. However, in multivariate analysis, only the combination of a prothrombotic risk factor with an underlying condition (OR 3.9, 95% CI 1.8 to 8.6), increased Lp(a) (OR 4.1, 95% CI 2.0 to 8.7), and protein C deficiency (OR 11.1, 95% CI 1.2 to 104.4) had independent associations with CVT in the children investigated. Conclusions— CVT in children is a multifactorial disease that, in the majority of cases, results from a combination of prothrombotic risk factors and/or underlying clinical condition. |
| Author | Kurnik, Karin Kosch, Andrea Heller, Christine Knöfler, Ralf Junker, Ralf Heinecke, Achim von Eckardstein, Arnold Sträter, Ronald Zieger, Barbara Schobess, Rosemarie Nowak-Göttl, Ulrike |
| Author_xml | – sequence: 1 givenname: Christine surname: Heller fullname: Heller, Christine organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 2 givenname: Achim surname: Heinecke fullname: Heinecke, Achim organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 3 givenname: Ralf surname: Junker fullname: Junker, Ralf organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 4 givenname: Ralf surname: Knöfler fullname: Knöfler, Ralf organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 5 givenname: Andrea surname: Kosch fullname: Kosch, Andrea organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 6 givenname: Karin surname: Kurnik fullname: Kurnik, Karin organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 7 givenname: Rosemarie surname: Schobess fullname: Schobess, Rosemarie organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 8 givenname: Arnold surname: von Eckardstein fullname: von Eckardstein, Arnold organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 9 givenname: Ronald surname: Sträter fullname: Sträter, Ronald organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 10 givenname: Barbara surname: Zieger fullname: Zieger, Barbara organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland – sequence: 11 givenname: Ulrike surname: Nowak-Göttl fullname: Nowak-Göttl, Ulrike organization: From the Department of Pediatrics/Pediatric Hematology & Oncology, University of Frankfurt am Main (C.H.), Dresden (R.K.), Münster (A.K., R.S., U.N.-G.), Munich (K.K.), Halle (R.S.), and Freiburg (B.Z.), Germany; Institute of Medical Informatics and Biomathematics (A.H.) and Institute of Clinical Chemistry and Institute of Arteriosclerosis Research (R.J.), University of Münster, Münster, Germany; and Institute of Clinical Chemistry, University of Zürich (A.v.E.), Zürich, Switzerland |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15155619$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/12939214$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1161/circ.100.7.743 10.1016/S0887-8994(01)00291-0 10.1542/peds.96.2.291 10.1161/str.29.9.1765 10.1177/088307380101600807 10.1001/archinte.1994.00420070136016 10.1161/str.27.10.1721 10.1016/S0887-8994(00)00255-1 10.1007/s004310051026 10.1001/archneur.55.12.1539 10.1159/000054816 10.1056/NEJM200108093450604 10.1016/S0022-3476(96)70275-5 10.1161/atvb.19.10.2568 10.1016/B978-012743170-3/50107-2 10.1161/str.29.7.1398 10.1161/str.27.10.1724 10.1001/archneur.56.8.967 10.1093/bja/67.4.476 10.1016/S0165-5876(01)00524-9 10.1161/str.27.10.1731 10.1056/NEJM199806183382502 10.1007/s004310050877 10.1016/S0022-3476(95)70399-3 10.1542/peds.66.6.943 10.1016/0887-8994(92)90030-3 10.1177/088307380101600913 10.2307/2531779 10.1055/s-2002-32370 10.1007/s002470100517 10.1542/peds.95.1.138 10.1016/S0887-8994(00)00264-2 10.1212/WNL.54.6.1222 10.1227/00006123-199211000-00007 |
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| Keywords | Human Nervous system diseases Cerebral vein Cardiovascular disease Thrombosis Cerebral disorder Venous disease Vascular disease Etiology Central nervous system disease Risk factor pediatrics Diagnosis Child Cerebrovascular disease lipoproteins |
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The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma,... The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization,... BACKGROUND: The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma,... |
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| SubjectTerms | Adolescent Biological and medical sciences Cerebral Veins Child Child, Preschool Female Humans Infant Infant, Newborn Intracranial Thrombosis - diagnosis Intracranial Thrombosis - etiology Male Medical sciences Neurology Risk Factors Vascular diseases and vascular malformations of the nervous system Vascular Patency |
| Subtitle | A Multifactorial Origin |
| Title | Cerebral Venous Thrombosis in Children |
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