on May 28, 2009
Published online before print May 28, 2009, doi: 10.1161/STROKEAHA.109.550699
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Submitted on February 19, 2009
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.). * To whom correspondence should be addressed. 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.
Accepted on March 12, 2009
Anticoagulation in Childhood-Onset Arterial Ischemic Stroke With Nonmoyamoya Arteriopathy. Findings From the Colorado and German (COAG) Collaboration
Timothy J. Bernard MD*;
Key words: anticoagulation • arteriopathy • childhood stroke