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(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

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