engleski

Prothrombotic risk factors in childhood ischemic stroke and transient ischenmic attack in Croatia

Background: The etiology of stroke in children is still undetermined in up to one third of cases. There is increasing evidence that inherited or acquired prothrombotic disorders may be implicated in the etiology of stroke in childhood. Aims: The aim of this study was to determine the frequency of common inherited and acquired prothrombotic risk factors in children and adolescents with arterial ischemic stroke (AIS) and transient ischemic attacks (TIA) in Croatia, and to identify the possible association of two or more risk factors with the disease. Methods: We investigated 17 prothrombotic risk factors in blood samples from 124 children with an established diagnosis of AIS (N=47) and TIA (N=77) and in 42 children who represented the control group. Prothrombotic risk factors were classified into five groups: natural coagulation inhibitors (antithrombin, protein C, and free protein S antigen), blood coagulation factors (factor V Leiden and factor II 20210A), homocysteine pathway factors (total homocysteine, vitamin B12, serum folate and methylenetetrahydrofolate reductase C677T), lipid and lipoprotein profile (lipoprotein a, triglycerides, total, high- and low-density lipoprotein cholesterol) and antiphospholipid antibodies (lupus anticoagulant, anticardiolipin and antiphosphatidylserine antibodies). Results: At least one prothrombotic risk factor was identified in 87.2% children with AIS, in 88.3% with TIA and in 88.1% controls. A high number of various individual and combined prothrombotic risk factors, distributed among all risk factor groups, was found either in children with AIS or TIA. Three most common prothrombotic risk factors: low serum folate, MTHFR C677T and elevated Lp(a), were identified in approximately 30% of children in both patient groups. A more than a two-fold higher frequency of positive IgG antiphosphatidylserine antibody titer, was identified in children with AIS (17.2%), compared to controls (7.1%), The overall rate of three or more prothrombotic risk factors was significantly higher in children with AIS compared to controls (p=0.016). Conclusions: High frequency of multiple prothrombotic risk factors found in our study corroborates previous reports that a combination of risk factors rather than individual risk factors could contribute to AIS in children.

prothrombotic risk factors; childhood stroke and transient ischemic attack

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