DISORDERS IN THE HEMOSTASIS SYSTEM AS A RISK FACTOR IN ACUTE CEREBROVASCULAR ACCIDENTS IN CHILDREN
Main Article Content
Abstract
Purpose of the study – the purpose of the study is to evaluate the role of hemostasis system disorders in the development of cerebral strokes in children basing on the experience of Novosibirsk State Regional Clinical Hospital.
Materials and methods. A single-center retrospective non-controlled non-randomized study was conducted. The study included 38 children with ischemic stroke (IS) – 89.5 % and hemorrhagic stroke (HS) – 10.5 %, aged from 2 months to 15 years. All patients underwent neuroimaging, clinical and biochemical blood tests, evaluation of hemostasis parameters and hemostasis system gene polymorphism identification by PCR method. Statistical data was processed using Statistica 6.0 software package (StatSoft, Inc) with nonparametric statistical methods.
Results. The ratio of cases of HS and IS varied from 1 : 1 (in the group of children under 1 y.o.) to 1 : 20 (in the group older than 7 years). The main disease/condition that can be considered as the only risk factor for stroke was found in 34.2 % of children. No patients showed disorders that could cause a stroke and determine the nature of its course in the standard hemostasis system tests. In molecular genetic studies, homozygous carriage of the polymorphic variant of the PAI-1 (54.3 %) and FXII (44.5 %) genes was most common. All children with identified prothrombogenic mutations had a combination of at least 2 different polymorphisms.
Conclusion. The obtained results are important for the development of optimal care systems for children with stroke from the first clinical symptoms to the rehabilitation stage.
Keywords
Article Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
Organization of care for children with ischemic stroke. Guidelines /ed. T.T. Batysheva. M., 2018. 44 p. Russian (Организация помощи детям, перенесшим ишемический инсульт. Методические рекомендации /под ред. Т.Т. Батышевой. М., 2018. 44 с.)
Wilson JL, Dowling M, Fullerton HJ. Stroke in Children. Stroke. 2021; 52(10): 3388-3390. doi: 10.1161/STROKEAHA.121.033967
Thorvaldsen P, Asplund K, Kuulasmaa K, Rajakangas AM, Schrollet M. Stroke incidence, case fatality, and mortality in the WHO MONICA project. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease. Stroke. 1995; 26: 361-367
Amlie-Lefond C. Evaluation and Acute Management of Ischemic Stroke in Infants and Children. Continuum (Minneap Minn). 2018; 24(1): 150-170. doi: 10.1212/CON.0000000000000559
Mastrangelo M, Giordo L, Ricciardi G, De Michele M, Toni D, Leuzzi V. Acute ischemic stroke in childhood: a comprehensive review. Eur J Pediatr. 2022; 181(1): 45-58. doi: 10.1007/s00431-021-04212-x
Rivkin MJ, Bernard TJ, Dowling MM, Amlie-Lefond C. Guidelines for Urgent Management of Stroke in Children. Pediatr Neurol. 2016; 56: 8-17
Bernard TJ, Manco-Johnson MJ, Lo W, MacKay MT, Ganesan V, deVeber G et al. Towards a Consensus-based Classification of Childhood Arterial Ischemic Stroke. Stroke. 2012; 43(2): 371-377
deVeber GA, Kirton A, Booth FA, Yager JY, Wirrell EC, Wood E, et al. Epidemiology and Outcomes of Arterial Ischemic Stroke in Children: The Canadian Pediatric Ischemic Stroke Registry. Pediatr Neurol. 2017; 69: 58-70. doi: 10.1016/j.pediatrneurol.2017.01.016
Christerson S, Strömberg B. Childhood stroke in Sweden, I: incidence, symptoms, risk factors and short-term outcome. Acta Paediatr. 2010; 99(11): 1641-1649. doi: 10.1111/j.1651-2227.2010.01925.x
Mackay MT, Wiznitzer M, Benedict SL, Lee KJ, deVeber GA, Ganesan V. Arterial Ischemic Stroke Risk Factors: The International Pediatric Stroke Study. Ann Neurol. 2011; 69: 130-140
Kossorotoff M, Dinomais M, Chabrier S. Accident vasculaire ischémique cérébral chez l’enfant [Arterial ischemic stroke in children]. Rev Prat. 2021; 71(1): 75-78. French. PMID: 34160951
Jordan LC, Hillis AE. Challenges in the diagnosis and treatment of pediatric stroke. Nat Rev Neurol. 2011; 7(4): 199-208
Karpov SM, Burnusus NI, Golovanov VB, Vishlova IA, Shatochin AV. Ischemic stroke in childhood (clinical case). Pediatric Neurosurgery and Neurology. 2015; 4(46): 28-34. Russian (Карпов СМ, Бурнусус НИ, Голованов ВБ, Вышлова ИА, Шатохин АВ. Ишемический инсульт в детском возрасте (клинический случай) //Нейрохирургия и неврология детского возраста. 2015. № 4(46). С. 28-34)
Gerstl L, Weinberger R, Heinen F, Bonfert MV, Borggraefe I, Schroeder AS, et al. Arterial ischemic stroke in infants, children, and adolescents: results of a Germany-wide surveillance study 2015-2017. J Neurol. 2019; 266(12): 2929-2941. doi: 10.1007/s00415-019-09508-5
Lyle CA, Bernard TJ, Goldenberg NA. Child-hood arterial ischemic stroke: a review of etiologies, an-tithrombotic treatments, prognostic factors, and priorities for future research. Semin Thromb Hemost. 2011; 37(7): 786-793
Zharkov PA, Svirin PV, Larina LE, Roytman EV, Vdovin VV, Rumyantsev AG. The risk of ischemic stroke in children carriers of prothrombotic polymorphisms. Pediatrics named after G.N. Speransky. 2015; 94(3): 99-104. Russian (Жарков ПА, Свирин ПВ, Ларина ЛЕ, Ройтман ЕВ, Вдовин ВВ, Румянцев АГ. Риск развития ишемического инсульта у детей – носителей протромботических полиморфизмов //Педиатрия. 2014. Т. 94, № 3. С. 99-104)
Zhdanova LV. Genetically determined thrombophilia in childhood. Bulletin of the Buryat State University. 2015; 12: 114-122. Russian (Жданова ЛВ. Генетически детерминированные тромбофилии в детском возрасте //Вестник Бурятского государственного университета. 2015. № 12. С. 114-122)
Kenet G, Lutkhoff LK, Albisetti M, Bernard T, Bonduel M, Brandao L, et al. Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and metaanalysis of observational studies. Circulation. 2010; 121(16): 1838-1847
Database «1000 Genomes Project Phase 3 allele frequencies». Russian (База данных «1000 Genomes Project Phase 3 allele frequencies») http://grch37.ensembl.org/