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(Stroke. 2009;40:65.)
© 2009 American Heart Association, Inc.

Original Contributions

Factor V Leiden and Antiphospholipid Antibodies in Either Mothers or Infants Increase the Risk for Perinatal Arterial Ischemic Stroke

Michal J. Simchen, MD; Gal Goldstein, MD; Aaron Lubetsky, MD; Tzipi Strauss, MD; Eyal Schiff, MD Gili Kenet, MD

From Department of Obstetrics and Gynecology (M.J.S., E.S.) and the Pediatric Coagulation Service (T.S., G.K., G.G.), National Hemophilia Center and Institute of Thrombosis and Hemostasis (A.L., G.K.), Sheba Medical Center, Tel Hashomer, Israel, and Sackler Medical School, Tel-Aviv University, Israel.

Correspondence to Gili Kenet, MD, Director, Thrombosis Unit, National Hemophilia Center, Sheba Medical Center, Tel-Hashomer, Israel, 52621. E-mail gili.kenet{at}sheba.health.gov.il

Background and Purpose— The objective was to investigate the role of infant and maternal thrombophilia in a cohort of mothers and infants presenting with perinatal arterial ischemic stroke.

Methods— Forty-seven infants with clinically and radiologically confirmed perinatal arterial ischemic stroke underwent thrombophilia workup: factor V Leiden (FVL), PII20210A mutation, Methylene-tetrahydrofolate reductase 677T polymorphism, protein C, protein S, antithrombin, FVIII, and antiphospholipid antibodies. Thrombophilia data were available for 23 mother–infant pairs and compared with control populations to evaluate the risk for PAS.

Results— Thirty of 47 (64%) infants and 15 of 22 mothers (68%) had evidence of thrombophilia. In 18 of 23 (78%) mother–infant pairs, there was at least 1 thrombophilic risk factor, but 15 pairs were mismatched in pathology. Among infants, FVL, protein C deficiency, and presence of antiphospholipid antibodies prevailed (OR, 4.2; 95% CI, 1.5–11.3; OR, 12.2; 95% CI, 2.5–59.9; OR, 4.1; 95% CI, 1.4–12.2, respectively). Interestingly FVL prevailed in almost one-third of mothers (OR, 8.5; 95% CI, 4.1–17.5) and 18% of mothers had antiphospholipid antibodies (OR, 3.8l; 95% CI, 1.5–10.0).

Conclusions— Maternal and neonatal thrombophilia, especially presence of FVL or antiphospholipid antibodies, may be important in the pathogenesis of perinatal arterial ischemic stroke. The nature of thrombophilic mother–infant risk potential interactions warrants further investigation.

Key Words: antiphospholipid antibodies • FVL • perinatal ischemic stroke • thrombophilia