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Evaluation of hypercoagulability state in perinatal arterial ischemic stroke with rotation thromboelastometry

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Abstract

Background

Perinatal arterial ischemic stroke (PAIS) is an important cause of pediatric morbidity and mortality. The etiology of PAIS remains unknown. Several maternal-neonatal disorders, and especially prothrombotic risk factors, have been reported in infants with perinatal stroke (PS). Rotation thromboelastometry (ROTEM) can analyze the coagulation system, from the beginning of coagulation, through clot formation, and ending with fibrinolysis. The aim of this study was to evaluate the hypercoagulability state in PAIS patients using ROTEM.

Methods

Patients were obtained by evaluating hospital files retrospectively. Twenty patients with PAIS and 19 healthy controls were included in the study. Prothrombotic risk factors and standard coagulation parameters were collected for all patients. Thromboelastometry (TEM) analysis was performed with the ROTEM® Coagulation Analyzer model Gamma 2500 (Tem International, Munich, Germany). Patients were separated into two groups; Group 1 included PAIS patients with prothrombotic risk factors and Group 2 included patients with no prothrombotic risk factors.

Results

Group 1 includes six patients and Group 2 includes fourteen. Maternal risk factors were reported in 55 % and prothrombotic risk factors were detected in 30 % of the patients. ROTEM analyses were done mean age of 11.2 ± 9.4 months. ROTEM analysis showed that maximum clot firmness (MCF) value on both groups was significantly higher than in the control group, which is consistent with a hypercoagulable state. There was no statistical difference between the MCF values of Group 1 and Group 2. No significant correlations were found between the ROTEM parameters and the hematological parameters.

Conclusion

The etiology of PAIS is still unclear. Prothrombotic risk factors may be an important etiology for PAIS. However, standard hematological tests for evaluating prothrombotic risk factors are limited. In our study, ROTEM analyses showed higher maximum clot firmness in PAIS patients compared to controls. ROTEM analyses may suggest a hypercoagulable state due to abnormal fibrinolysis in PAIS patients. Normative data and further research is needed to validate our findings.

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Authors and Affiliations

  1. Department of Pediatric Neurology, Samsun Training and Research Hospital, Ilkadim, Samsun, Turkey

    Ozan Kocak

  2. Department of Pediatric Neurology, Eskisehir Osmangazi University Hospital, Eskisehir, Turkey

    Coskun Yarar

  3. Department of Pediatric Hematology and Oncology, Eskisehir Osmangazi University Hospital, Eskisehir, Turkey

    Ayşe Bozkurt Turhan

  4. Department of Hematology, Eskisehir Osmangazi University Hospital, Eskisehir, Turkey

    Olga Meltem Akay

  5. Department of Pediatric Neurology, Eskisehir Osmangazi University Hospital, Eskisehir, Turkey

    Kursat Bora Carman & Ayten Yakut

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  1. Ozan Kocak
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  2. Coskun Yarar
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Correspondence to Ozan Kocak.

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Kocak, O., Yarar, C., Turhan, A.B. et al. Evaluation of hypercoagulability state in perinatal arterial ischemic stroke with rotation thromboelastometry. Childs Nerv Syst 32, 2395–2401 (2016). https://doi.org/10.1007/s00381-016-3213-0

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  • DOI: https://doi.org/10.1007/s00381-016-3213-0

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