This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sträter, R. Articles by Nowak-Göttl, U. Search for Related Content PubMed PubMed Citation Articles by Sträter, R. Articles by Nowak-Göttl, U. Related Collections Other Treatment Risk Factors for Stroke Stroke in Children and the Young Anticoagulants Antiplatelets

(Stroke. 2001;32:2554.)
© 2001 American Heart Association, Inc.

Original Contributions

Aspirin Versus Low-Dose Low-Molecular-Weight Heparin: Antithrombotic Therapy in Pediatric Ischemic Stroke Patients

A Prospective Follow-Up Study

Ronald Sträter, MD; Karin Kurnik, MD; Christine Heller, MD; Rosemarie Schobess, MD; Petra Luigs; Ulrike Nowak-Göttl, MD for the Childhood Stroke Study Group

From the Department of Pediatrics, University of Münster (R.S., P.L., U.N-G.), University of Munich (K.K.), University of Frankfurt/Main (C.H.), and University of Halle (R.S.) (Germany). All authors contributed equally to this work.

Correspondence to Professor Dr U. Nowak-Göttl, Department of Pediatric Hematology and Oncology, University of Münster, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany. E-mail leagottl{at}uni-muenster.de

Background and Purpose—— We sought to compare different antithrombotic secondary treatments (mainly medium-dose aspirin with low-dose low-molecular-weight heparin [LMWH]) in pediatric patients with a first ischemic stroke onset with regard to the risk of stroke recurrence.

Methods—— The population comprised 135 consecutively recruited children aged 6 months to 18 years with a first episode of ischemic stroke (idiopathic, n=79; cardiac, n=15; vascular, n=30; infectious, n=11). The stroke patients enrolled received prophylactic antithrombotic therapy (aspirin, n=49; LMWH, n=86) in a nonrandomized fashion and were prospectively followed up for a median (range) of 36 (8 to 48) months. The study end point was recurrent stroke.

Results—— Recurrent ischemic stroke was diagnosed at a median (range) of 5 (2 to 13) months after the first stroke onset in 13 of the 135 children (9.6%) receiving antithrombotic therapy. In the majority of cases (84.6%) the same vascular territory was involved. No significant difference was found with respect to the antithrombotic medication used (P=0.76, Fisher’s exact test). No major drug-related side effects were observed.

Conclusions—— This prospective multicenter follow-up study has provided evidence that low-dose LMWH is not superior to aspirin and vice versa in preventing recurrent stroke in white pediatric stroke patients. However, further adequately sized randomized trials are required to obtain reliable information on safety and efficacy with respect to the antithrombotic medications used.

Key Words: aspirin • heparin • risk factors • stroke, ischemic, pediatric • stroke, recurrent

This article has been cited by other articles:

				J Pappachan and F J Kirkham Cerebrovascular disease and stroke Arch. Dis. Child., October 1, 2008; 93(10): 890 - 898. [Abstract] [Full Text] [PDF]

				E. S. Roach, M. R. Golomb, R. Adams, J. Biller, S. Daniels, G. deVeber, D. Ferriero, B. V. Jones, F. J. Kirkham, R. M. Scott, et al. Management of Stroke in Infants and Children: A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young Stroke, September 1, 2008; 39(9): 2644 - 2691. [Abstract] [Full Text] [PDF]

				P. Monagle, E. Chalmers, A. Chan, G. deVeber, F. Kirkham, P. Massicotte, and A. D. Michelson Antithrombotic Therapy in Neonates and Children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 887S - 968S. [Abstract] [Full Text] [PDF]

				A. Papavasiliou, H. Bazigou-Fotopoulou, and H. Ikeda Familial Moyamoya Disease in Two European Children J Child Neurol, December 1, 2007; 22(12): 1371 - 1376. [Abstract] [PDF]

				V. Ganesan, M. Prengler, A. Wade, and F. J. Kirkham Clinical and Radiological Recurrence After Childhood Arterial Ischemic Stroke Circulation, November 14, 2006; 114(20): 2170 - 2177. [Abstract] [Full Text] [PDF]

				H. J. Fullerton The Emerging Quandary of Childhood Stoke: Better Aim but No Magic Bullet Stroke, January 1, 2006; 37(1): 3 - 3. [Full Text] [PDF]

				S. Kuhle, L. Mitchell, M. Andrew, A. K. Chan, P. Massicotte, M. Adams, and G. deVeber Urgent Clinical Challenges in Children With Ischemic Stroke: Analysis of 1065 Patients From the 1-800-NOCLOTS Pediatric Stroke Telephone Consultation Service Stroke, January 1, 2006; 37(1): 116 - 122. [Abstract] [Full Text] [PDF]

				G. deVeber, A. Chan, U. Nowak-Gottl, and R. Strater Aspirin Versus Low-Molecular-Weight Heparin for Ischemic Stroke in Children: An Unanswered Question * Response Stroke, August 1, 2002; 33(8): 1947 - 1948. [Full Text] [PDF]

				M. Marietta, M. Bertesi, N. Rozzi, M. C. Cano, S. Vallone, C. Cappi, S. Pozzi, and G. Torelli Low-Molecular-Weight Heparin for Vertebral Artery Dissection Clinical and Applied Thrombosis/Hemostasis, April 1, 2002; 8(2): 179 - 181. [Abstract] [PDF]

				Aspirin vs. LMWH for Secondary Stroke Prevention in Children Journal Watch Neurology, March 8, 2002; 2002(308): 3 - 3. [Full Text]