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Hemorrhagic Transformation Following Childhood Cardioembolic Stroke Is Not Increased in Anticoagulated Patients
Pin-Yi Ko1, Hedieh Khalatbari2, Danielle Hatt3
1Department of Neurology, Seattle Children's Hospital, University of Washington, Seattle, WA.
Insights
Hemorrhagic transformation occurred in 11% of childhood cardioembolic strokes, typically within 2 days. Anticoagulation and stroke size did not impact this risk, but inpatient strokes showed a higher risk.
Area of Science:
- Pediatric Neurology
- Cardiovascular Research
- Stroke Medicine
Background:
- Cardioembolic stroke is a significant concern in children.
- Hemorrhagic transformation (HT) is a potential complication of ischemic stroke.
- Understanding risk factors for HT in pediatric cardioembolic stroke is crucial for management.
Purpose of the Study:
- To determine the incidence of hemorrhagic transformation (HT) after cardioembolic stroke in children.
- To investigate the impact of anticoagulation therapy on the risk of HT.
- To identify other potential predictors of HT in this population.
Main Methods:
- Retrospective chart review of 95 children diagnosed with cardioembolic arterial ischemic stroke between 2009 and 2019.
- Analysis of neuroimaging to identify and quantify hemorrhagic transformation.
- Comparison of HT rates between patients who received anticoagulation and those who did not.
Main Results:
- Hemorrhagic transformation occurred in 11% of pediatric cardioembolic ischemic strokes, with most cases (8/11) developing within 2 days of diagnosis.
- The risk of HT was similar in patients with (15%) and without (9%) anticoagulation.
- Stroke size did not predict HT, but inpatient strokes had a higher HT risk (16%) compared to outpatient strokes (6%).
Conclusions:
- Hemorrhagic transformation is a recognized complication of pediatric cardioembolic stroke.
- Anticoagulation therapy and stroke size were not found to be significant risk factors for HT in this cohort.
- Inpatient setting may be associated with an increased risk of HT following pediatric cardioembolic stroke.
Objective:
To characterize the risk of hemorrhagic transformation following cardioembolic stroke in childhood, and whether anticoagulation impacts that risk.
Methods:
Ninety-five children (1 month-18 years) with cardioembolic arterial ischemic stroke between January 1, 2009, and December 31, 2019, at 2 institutions were identified for retrospective chart review. Neuroimaging was reviewed to assess for hemorrhagic transformation.
Results:
There were 11 cases of hemorrhagic transformation; 8 occurred within 2 days of stroke diagnosis. Risk of hemorrhagic transformation did not differ in patients with and without anticoagulation use (15% vs 9%, estimated risk difference 5%; CI -9%, 19%). Stroke size did not predict hemorrhagic transformation (OR 1.004, 95% CI 0.997, 1.010). Risk of hemorrhagic transformation was higher in strokes that occurred in the inpatient compared with the outpatient setting (16% vs 6%).
Conclusion:
Hemorrhagic transformation occurred in 11% of pediatric cardioembolic ischemic stroke, usually within 2 days of stroke diagnosis, and was not associated with anticoagulation or stroke size.
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