Perinatal ischemic stroke and the incidence of maternal and neonatal thrombophilia

Abstract

NEONATAL THROMBOPHILIA MICHAL SIMCHEN, GAL GOLDSTEIN, AHARON LUBETSKY, I. TAMARIN, MORDECHAI DULITZKI, EYAL SCHIFF, GILI KENET, Tel-Aviv University, Obstetrics and Gynecology, Ramat Gan, Israel, Sheba Medical Center, National Hemophilia Center, Ramat Gan, Israel, Tel-Aviv University, Ramat Gan, Israel, Sheba Medical Center, Institute of Thrombosis and Hemostasis, Ramat Gan, Israel, Sheba Medical Center, Tel Aviv University, Obstetrics and Gynecology, RamatGan, Israel, Sheba medical Center, Tel Aviv University, Obstetrics and Gynecology, Ramat Gan, Israel, Tel-Aviv University, Pediatric Coagulation Service, Ramat Gan, Israel OBJECTIVE: Perinatal arterial ischemic stroke (PAS), defined as occurring between 28 weeks’ gestation-7 days of postnatal age, is reported in 1:4000 live births. We aimed to investigate thrombophilia risk factors in a cohort of mothers and infants presenting with PAS. STUDY DESIGN: The prevalence of thrombophilic risk factors among perinatal stroke patients was assessed from data of the Israeli Pediatric Stroke registry. Of 136 pediatric stroke patients, 47 children with radiologically (CT or MRI) confirmed perinatal stroke were referred for thrombophilia workup. Maternal thrombophilia screening was recommended. 16 maternal-infant pairs have undergone a complete thrombophilia workup – genetic (Factor V Leiden, Prothrombin 20210Amutation,MTHFR677Tpolymorphism, ProteinC, Protein S, Antithrombin,FactorVIII) andacquired (LupusAnticoagulant,Anticardiolipin IgG & IgM, B2 Glycoprotein-1), and are the subject of this report. RESULTS: In all but one of the 16 mother-infant pairs, there was some thrombophilic risk factor present for either infant or mother, but in 11 motherinfant pairs (68.8%) there was discordance in pathology. Ten (62.5%) infants were found to have a thrombophilic risk factor, genetic or acquired. Of these, 9 had genetic thrombophilic risk factors, of which 3 had combined genetic risk factors (2 or more). Four had acquired antiphospholipid antibodies, 3 of which were in combination with genetic thrombophilia. 11/16 (68.8%) mothers were found to have thrombophilia, 3 had combined 2 or more genetic thrombophilia risk factors, and 3 had combined genetic and acquired antibodies. CONCLUSION: The high rate of thrombophilic risk factors among mother and infants with PAS, as well as the discordance of mother-infant thrombophilia, suggest that interactions between thrombophilic risk factors may play an important role in the pathogenesis of perinatal ischemic stroke. The nature of interaction between maternal and neonatal risk factors appears to involve several as yet undefined mechanisms, and warrants further investigation.