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Antithrombotic therapy for secondary stroke prevention in bacterial meningitis in children
Cyrus Boelman1, Manohar Shroff2, Ivanna Yau1
1Division of Neurology, Hospital for Sick Children, Toronto, Canada.
Insights
Antithrombotic therapy (ATT) like heparin and aspirin appears safe for preventing recurrent strokes in children with bacterial meningitis. Heparin may offer better protection against further strokes than aspirin.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Cardiovascular Research
Background:
- Childhood bacterial meningitis is a serious condition that can lead to stroke.
- Secondary stroke prevention in this population requires effective and safe therapeutic strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of antithrombotic therapy (ATT) for preventing recurrent strokes in children diagnosed with bacterial meningitis.
- To compare the effectiveness of different ATT agents, specifically heparin and aspirin, in this context.
Main Methods:
- A retrospective analysis of 22 pediatric cases of bacterial meningitis complicated by stroke over 15 years.
- Inclusion criteria: age 28 days to 18 years, with at least two serial neuroimaging studies.
- Safety assessed by intracranial hemorrhage; efficacy by stroke recurrence; outcomes by Pediatric Stroke Outcome Measure.
Main Results:
- Six patients treated with heparin showed no recurrent infarctions.
- Ten patients received aspirin (acetylsalicylic acid), with 40% experiencing further infarctions; 3 later received heparin.
- Fourteen patients received no ATT, and 57% had recurrent infarctions. No intracranial hemorrhages were observed with either heparin or aspirin.
Conclusions:
- Antithrombotic therapy, including heparin and aspirin, is safe for children with meningitis-associated stroke.
- Heparin demonstrated potentially greater efficacy than aspirin in preventing recurrent stroke in this cohort.
- Further research is warranted to confirm these findings in larger studies.
Objective:
To assess the safety and efficacy of antithrombotic therapy (ATT) for secondary stroke prevention of childhood bacterial meningitis.
Study Design:
A retrospective study of cases of stroke associated with bacterial meningitis in 2 pediatric hospitals during a period of 15 years. Patients were included in the study if they were between 28 days and 18 years of age and had at least 2 serial neuroimaging studies during the acute phase of their illness. The safety of ATT was assessed by the presence or absence of intracranial hemorrhage. Efficacy was assessed by the failure in preventing stroke recurrence. Neurologic outcome was determined by the last documented Pediatric Stroke Outcome Measure score.
Results:
Twenty-two cases of childhood bacterial meningitis complicated by stroke were identified. Six cases were treated with heparin after either initial or recurrent infarction. None of the cases receiving heparin had further recurrence. Aspirin (acetylsalicylic acid [ASA]) was started after the initial or after recurrent infarction in 10 cases. Four (40%) had infarctions on ASA; 3 of these patients subsequently received heparin. In the 14 cases in which no ATT was begun, 8 (57%) had further recurrence of infarction. None of the patients, whether receiving heparin or ASA, had intracranial hemorrhage.
Conclusion:
In this small sample, heparin and ASA appeared to be safe in childhood bacterial meningitis complicated by stroke and may be effective in improving outcome. Heparin may be more effective than aspirin in preventing recurrent infarction.
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