PROTHROMBOTIC DISORDERS IN CHILDREN WITH ISCHEMIC STROKE IN TAIWAN

Objectives: To study the prevalence of different prothrombotic states in Taiwanese children with ischemic stroke and to describe their clinical characteristics and prognosis.

Methods: Hospital records from 1995 to 2004 admitted to a tertiary medical center were reviewed, using the ICD-9 codes about ischemic stroke (342, 433, 434, 435, 436, 437, and 438). A total of 106 patients with ischemic stroke ranged from 2 months old to 18 years old were included. Magnetic resonance imaging and computed tomography were used to identify patients with ischemic stroke. Blood sampling for measurements of inhibitor proteins (Antithrombin III, Protein C (PC), and Protein S (PS)), antiphospholipid antibody, lupus anticoagulants or plasminogen levels were done in 50 of these 106 patients. Statistical analysis was done using Mann-Whitney test and Chi-square or Fisher's exact test.

Results: 12 of the 50 patients were shown to have inhibitor proteins deficiencies (PC deficiency: 7(58%); PS deficiency: 2(17%); combined PC and PS deficiencies: 3(25%)). As compared with the non-prothrombotic group of children with ischemic stroke, the prothrombotic group have a younger onset age (mean age: 3 years and 3 months, p<0.01), higher recurrence rate (50% vs. 39%; p=0.52), higher rate of epilepsy (p<0.01) and higher mortality rate (25% vs. 10%; p=0.34).

Conclusion: Prothrombotic disorders, especially inhibitor proteins deficiencies, are found to be important causes of childhood ischemic stroke in Taiwan as compared with Caucasian population. Since these are associated with an earlier onset age, higher recurrence rate and thus increased morbidity and mortality, a comprehensive analysis including coagulation profile should be checked in Taiwanese children with ischemic stroke.