Paediatric stroke. Who should be treated?

Area of Science:

• Neurology
• Pediatrics
• Hematology

Background:

• Pediatric stroke research has significantly increased over the last decade.
• Limited studies have focused on antithrombotic safety and efficacy in children.
• Three recent pediatric stroke guidelines integrate research and expert consensus.

Purpose of the Study:

• To review and synthesize current treatment guidelines for pediatric stroke.
• To outline antithrombotic treatment recommendations for different pediatric stroke types.
• To address the safety and effectiveness of antithrombotic therapies in pediatric populations.

Main Methods:

• Analysis of three recently published pediatric stroke guidelines.
• Comparison of treatment recommendations for arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT).
• Evaluation of antithrombotic strategies including anticoagulation and antiplatelet therapy.

Main Results:

• Newborns with AIS have a low recurrence risk and rarely need antithrombotics.
• Children with AIS have a significant recurrence risk, necessitating antithrombotic treatment unless contraindicated.
• Anticoagulation is recommended for dissection and embolism in AIS; antiplatelet therapy for others.
• Neonatal CSVT management involves initial anticoagulation if no hemorrhage, otherwise monitoring.
• Children with CSVT, including those with hemorrhagic infarction, generally receive anticoagulation.

Conclusions:

• Current pediatric stroke guidelines provide consistent treatment recommendations for most patients.
• Specific antithrombotic strategies are outlined for AIS and CSVT in neonates and children.
• While further research is needed, existing guidelines offer valuable interim guidance for pediatric stroke management.