Thrombophilia risk is not increased in children after perinatal stroke
Perinatal stroke is the leading cause of hemi-paretic cerebral palsy. This study aimed to prospectively identify the rates of thrombophilia in children with perinatal stroke and compare it to healthy case-controls, thus determine the need for thrombophilia testing in this population.
This was a single-center, prospective, population-based, case-control study. 135 patients with perinatal stroke were identified throught the Alberta Perinatal Stroke Project registry. They were classified as having non-ischemic arterial stroke (NAIS), arterial presumed perinatal stroke (APPIS), or fetal periventricular venous infarction (PVI) based on MRI finding and absence of identifiable etiologies. These patients had thrombophilia testing at 12 months of age or at the time of presentation (if older than 12 months as with cases of APPIS). Testing included quantified proteins C and S, antithrombin, factors VIII/ IX/ XI, fibrinogen, lipoprotein(a), homocysteine, lupus anticoagulant, anticadiolipin antibodies, and genotyping Factor V Leiden (FVL), Factor II G20210A, and MTHFR C677T mutations. 77 Control participants were age and sex matched from healthy patients undergoing elective procedures. Control patient samples were used to identify normal ranges for the laboratory measures and as comparison to values from the prothrombotic group. The primary outcome measure was to determine any association between perinatal stroke diseases and thrombophila.
No difference was seen in 12 out of the 14 parameters, including all the thrombophilias. Mean INR and PTT were marginally shorter in children with NAIS. The rates of FVL, FII, and MTHFR mutations were similar to controls. Antiphospholipid antibodies were also comparable to controls and resolved on repeat testing. The total number of abnormalities was also comparable between the groups. There were no cases of stroke recurrence.
Limitations included failing to test mothers of neonates and not testing some described thrombophilias associated with stroke (ex. ADAMTS13). Thrombophilia testing done at 12 months does not account for possibility of disordered coagulation during the acute time of stroke. Data on family history of thrombosis was not included.