Published Online
on November 20, 2003

A more recent version of this article appeared on December 1, 2003

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Submitted on August 25, 2003
Accepted on August 27, 2003

Recurrent Thromboembolism in Infants and Children Suffering From Symptomatic Neonatal Arterial Stroke. A Prospective Follow-Up Study

Karin Kurnik MD; Andrea Kosch MD; Ronald Sträter MD; Rosemarie Schobess MD; Christine Heller MD; Ulrike Nowak-Göttl MD^*; and for the Childhood Stroke Study Group

From the Department of Paediatrics, University of Munich, Munich (K.K.); Department of Paediatric Hematology/Oncology, University of Münster, Münster (A.K., R.S., U.N.-G.); Department of Paediatrics, University of Halle an der Saale, Halle an der Saale (R.S.); and Department of Paediatrics, University of Frankfurt, Frankfurt (C.H.), Germany.

^* To whom correspondence should be addressed. E-mail: leagottl{at}uni-muenster.de.

Background and Purpose--The present study was performed to evaluate the rate of recurrent symptomatic thromboembolism with respect to prothrombotic risk factors and underlying clinical conditions.

Methods--In a series of 215 consecutively enrolled neonates with arterial ischemic stroke (AIS), the factor V G1691A mutation, factor II G20210A variant, methylenetetrahydrofolate reductase (MTHFR) T677T genotype, lipoprotein (Lp) (a), antithrombin, protein C, protein S, and anticardiolipin antibodies (ACA) were investigated. Patient median follow-up was 3.5 years (range, 1 to 8 years).

Results--During follow-up, 7 infants and children (3.3%) showed recurrent symptomatic thromboembolism (AIS, n=4; venous sinus thrombosis, n=2; deep vein thrombosis of the leg, n=1). The factor V mutation, factor II variant, elevated Lp(a) >30 mg/dL, protein C deficiency, and protein S or antithrombin deficiency were associated with first stroke onset. In 5 of 7 cases (71.4%), prothrombotic risk factors [MTHFR T677T, elevated Lp(a), hyperhomocysteinemia, protein C deficiency] were involved at the time of recurrence. Furthermore, a second thromboembolic event was triggered additionally by underlying diseases (71%), eg, cardiac malformation and immobilization, diarrhea, mastoiditis, and moyamoya syndrome.

Conclusions--Data shown here give evidence that symptomatic recurrent thromboembolism is not common in children with neonatal AIS. The risk of a second event, however, is increased when underlying diseases occur and prothrombotic risk factors are involved.

Key words: infant, newborn • lipoproteins • protein C deficiency • stroke • thromboembolism

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