Factor V Leiden and antiphospholipid antibodies are significant risk factors for ischemic stroke in children.
OBJECTIVE
The association between ischemic childhood stroke and thrombophilia has been debated. We studied the prevalence of thrombophilia risk factors in 65 unrelated children with ischemic stroke compared with 145 control subjects.


METHODS
Patients and control subjects were tested for antithrombin protein C and protein S deficiencies, the presence of antiphospholipid antibodies (APLA), factor V Leiden (FVL), G20210A polymorphism of factor II gene (FII G20210A), and C677T polymorphism of 5,10-methylenetetrahydrofolate reductase gene (C677T MTHFR).


RESULTS
Of 65 children, 7 had a stroke in the neonatal/perinatal period and therefore were analyzed separately. Thirty-one of the remaining 58 patients with pediatric stroke (53.4%) were found to have at least 1 thrombophilia marker compared with only 25.5% of control subjects. None of the patients or control subjects had protein S or antithrombin III deficiency. The prevalence of protein C deficiency was higher among pediatric stroke patients than among control subjects, but the difference was not statistically significant (OR=7, 95% CI 0.75 to 65.1). Heterozygous FII G20210A and homozygous MTHFR 677T were not associated with an increased risk for stroke (OR=1.29, 95% CI 0.2 to 8.2; and OR=1.06, 95% CI 0.4 to 2.7, respectively). In contrast, the presence of APLA was associated with a >6-fold risk of stroke (OR=6. 08, 95% CI 1.5 to 24.3), and the heterozygosity for FVL increased the risk of stroke by almost 5-fold (OR=4.82, 95% CI 1.4 to 16.5). Five patients with pediatric stroke had a combination of > or =2 thrombophilia markers, whereas none of the control subjects had a combination of the markers. Most of the patients with neonatal/perinatal stroke were found to have at least 1 thrombophilia marker.


CONCLUSIONS
These data suggest that the prevalence of thrombophilia markers is increased in children with stroke compared with control subjects and, specifically, that FVL and APLA contribute significantly to stroke occurrence.
Kenet
G
G
Institute of Thrombosis and Haemostasis, Sheba Medical Center, Tel Hashomer, Israel.
Sadetzki
S
S
Murad
H
H
Martinowitz
U
U
Rosenberg
N
N
Gitel
S
S
Rechavi
G
G
Inbal
A
A
D020413:3' Untranslated Regions / Q000235:genetics; D000293:Adolescent; D017668:Age of Onset; D017152:Antibodies, Antiphospholipid / Q000032:analysis*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000453:epidemiology* / Q000276:immunology; D001327:Autoimmune Diseases / Q000150:complications / Q000453:epidemiology / Q000276:immunology; D015415:Biomarkers; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005006:Ethnicity / Q000235:genetics; D005165:Factor V / Q000235:genetics*; D005166:Factor V Deficiency / Q000150:complications / Q000453:epidemiology* / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D016017:Odds Ratio; D000587:Oxidoreductases Acting on CH-NH Group Donors / Q000172:deficiency / Q000235:genetics; D017354:Point Mutation; D011110:Polymorphism, Genetic; D020151:Protein C Deficiency / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D011516:Prothrombin / Q000235:genetics; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology
D020413:3' Untranslated Regions; D017152:Antibodies, Antiphospholipid; D015415:Biomarkers; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin; D000587:Oxidoreductases Acting on CH-NH Group Donors; D042965:Methylenetetrahydrofolate Reductase (NADPH2)