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Safety of anticoagulants in children with arterial ischemic stroke

Tal Schechter1, Adam Kirton, Suzanne Laughlin

  • 1Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. tal.schechter-finkelstein@sickkids.ca

Blood
|December 14, 2011
PubMed

Insights

Anticoagulant therapy (ACT) is relatively safe for pediatric arterial ischemic stroke (AIS), with a low risk of symptomatic intracranial hemorrhage (ICH). This finding supports further clinical trials of ACT in childhood AIS.

Area of Science:

  • Neurology
  • Pediatric Medicine
  • Hematology

Background:

  • Pediatric arterial ischemic stroke (AIS) is a growing concern with significant risks.
  • Anticoagulant therapy (ACT) is frequently used in children with AIS.
  • Data on hemorrhagic complications and adult safety data applicability in pediatric stroke are limited.

Purpose of the Study:

  • To assess the frequency, characteristics, predictors, and outcomes of ACT-associated intracranial hemorrhage (ICH) in children with AIS.
  • To evaluate the safety of ACT in this pediatric population.

Main Methods:

  • Analysis of a prospectively enrolled cohort of children (1 month-18 years) with acute AIS.
  • Protocol-based ACT was administered to selected patients over a 14-year period.
  • Assessment of new or increased ICH during and after anticoagulation.

Main Results:

  • 11% of children receiving ACT developed new or increased ICH within 26 days of diagnosis.
  • Symptomatic ICH occurred in 4% of patients, with most cases being mild.
  • Long-term outcomes after ICH were abnormal in 73% of survivors.
  • 16% of children not treated with anticoagulation also developed ICH on follow-up.

Conclusions:

  • ACT is relatively safe in pediatric AIS, with a 4% risk of symptomatic ICH.
  • The safety profile supports the use of ACT in this population.
  • Clinical trials investigating ACT for childhood AIS are warranted.

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