This Article Full Text Full Text (PDF) All Versions of this Article: 40/8/2869    most recent STROKEAHA.109.550699v1 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 Google Scholar Articles by Bernard, T. J. Articles by Nowak-Göttl, U. PubMed PubMed Citation Articles by Bernard, T. J. Articles by Nowak-Göttl, U. Related Collections Heparin Anticoagulants Other Vascular biology

(Stroke. 2009;40:2869.)
© 2009 American Heart Association, Inc.

Research Letters

Anticoagulation in Childhood-Onset Arterial Ischemic Stroke With Nonmoyamoya Arteriopathy

Findings From the Colorado and German (COAG) Collaboration

Timothy J. Bernard, MD; Neil A. Goldenberg, MD, PhD; Mark Tripputi, MS; Marilyn J. Manco-Johnson, MD; Thomas Niederstadt, MD Ulrike Nowak-Göttl, MD

From the Sections of Child Neurology (T.J.B.) and Hematology/Oncology/BMT (N.A.G., M.J.M.-J.), Department of Pediatrics, the Department of Biostatistics and Informatics (M.T.), and the Hemophilia and Thrombosis Center (T.J.B., N.A.G., M.J.M.-J.), University of Colorado Denver and The Children’s Hospital, Denver, Colo; and the Institute of Clinical Radiology/Neuroradiology (T.N.) and the Department of Pediatric Hematology/Oncology, University Children’s Hospital (U.N.-G.), University of Münster, Münster, Germany (T.N., U.N.-G.).

Correspondence Timothy J. Bernard, MD, Pediatric Neurology, B155, The Children’s Hospital, Denver, 13123 East 16th Avenue, Aurora, CO 80045. E-mail timothy.bernard{at}uchsc.edu

Background and Purpose— Childhood arterial ischemic stroke treatment guidelines recommend extended anticoagulation in cardioembolism and dissection. We sought to investigate the safety of extended anticoagulation in childhood arterial ischemic stroke with nonmoyamoya arteriopathy, for which the risk of recurrent stroke is high.

Methods— Thirty-seven patients with childhood-onset arterial ischemic stroke with acute arteriopathy (excluding moyamoya) were diagnosed between 1999 and 2007 and treated with anticoagulation for at least 4 weeks. Patients were followed in hospital-based cohort studies at 2 centers and systematically assessed for bleeding episodes and recurrent events.

Results— Over a cumulative anticoagulation duration of 1329 patient-months, there were no major bleeding episodes and 2 clinically relevant bleeding episodes. Cumulative probability of recurrent arterial ischemic stroke at 1 year was 14%.

Conclusions— Anticoagulation can be used safely for secondary arterial ischemic stroke prevention in children with acute nonmoyamoya arteriopathy. Anticoagulation is worthy of evaluation in future randomized, controlled treatment trials in this disease.

Key Words: anticoagulation • arteriopathy • childhood stroke