engleski

Deficiency of coagulation inhibitors in children with ischemic stroke and transient ischemic attack (TIA)

Coagulation inhibitors antithrombin (AT), protein C (PC), and protein S (PS) represent an important barrier to thrombosis. This factors inhibit mechanisms that counteract hemostasis contributing to an increased state of hypercoaguability and thereby can play an etiological role in stroke. The aim of the study was to investigate the frequency of decreased AT, PC and PS activities in children with ischemic stroke and TIA and try to find out at which degree deficiencies of coagulation inhibitors participate in the etiology of pediatric ischemic cerebrovascular events. Children less than 18 years age with radiological evidence of stroke (N=29) and TIA (N=45) were studied. Antithrombin and protein C activities were determined by using a chromogenic method (Berichrom AT (A) and Protein C, Dade Behring) on Sysmex CA– 500 analyzer. Free protein S was determined with ELISA (Asserachrom Free Protein S, Stago Diagnostics). In 38 of 74 investigated patients (51.4%), decreased activities of one coagulation inhibitor was present, decreased PC activity was present in 13.5%, free PS in 35.1% and AT in 2.7%. In children with ischemic stroke we found decreased PC activity in 10.3%, free PS in 31.0% and AT in 3.4% of patients, whilst the frequency of decreased activities in children with TIA was 13.3% for PC, 37.8% for free PS and 2.2% for AT. Combined PC and PS decreased activities were found in five patients (4 with TIA, and 1 with stroke). One child (2 years old with stroke) had combined PC and AT decreased activities. Half of our investigated group had at least one coagulation inhibitor deficiency being PS deficiency the most frequent. No significant difference of the frequencies of coagulation inhibitor deficiencies was found between children with stroke and TIA. Deficiency of coagulation inhibitors, especially PS, can participate in the etiology of pediatric ischemic cerebrovascular events, but it is very important to differentiate between congenital and acquired PC, PS and AT deficiencies.

coagulation inhibitors ; ischemic stroke ; transient ishemic attack

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