Etiology and treatment of perinatal stroke; a role for prothrombotic coagulation factors?

The detection rate of perinatal stroke is rising due to improved neuroradiological imaging techniques, increased survival of neonates with severe underlying diseases and an increased awareness of the diagnosis by pediatricians. Its pathogenesis is multifactorial and includes a large variety of maternal and neonatal risk factors as well as prothrombotic coagulation factors. Although the relative risk of prothrombotic coagulation factors is still unknown, testing is recommended to design large studies in the near future. This article is an overview of studies of prothrombotic risk factors in both neonatal arterial ischemic stroke and cerebral sinovenous thrombosis. Although prothrombotic coagulation factors are present in more than half of the cases, we conclude that they most likely play a minor role in the pathogenesis of perinatal stroke. Current therapeutic guidelines focusing on thrombosis are based on expert opinion and recommend low molecular weight or unfractionated heparin for cardioembolic arterial ischemic stroke, antiplatelet or anticoagulant therapy for recurrent arterial ischemic stroke, and low molecular weight heparin or unfractionated heparin for sinovenous thrombosis without hemorrhage and/or when extension of the thrombotic process occurs. (c) 2009 Elsevier Ltd. All rights reserved.