Hamostaseologie 2019; 39(S 01): S1-S92
DOI: 10.1055/s-0039-1680137
SY16 Paediatric and Neonatal Thrombosis
Georg Thieme Verlag KG Stuttgart · New York

Recurrent Pediatric Stroke: The Role of Thrombophilia in a Large International Pediatric Stroke Population

G. deVeber
1   The Hospital for Sick Children, Toronto, Canada
,
F. Kirkham
2   Institute of Child Health, Developmental Neurosciences Programme, Southampton, United Kingdom
3   University Hospital, Southampton, United Kingdom
,
L.R. Brandao
1   The Hospital for Sick Children, Toronto, Canada
,
R. Sträter
4   Department of Pediatric Hematology/Oncology, University of Münster, Münster, Germany
,
G. Kenet
5   National Haemophilia Centre and Institute of Thrombosis and Hemostasis Sheba Medical Centre, Pediatric Coagulation Service, Tel-Hashomer, Israel
,
M. Kausch
6   Institute of Clinical Chemistry, University Hospital Kiel-Lübeck, Kiel, Germany
,
M. Stoll
7   Department of Genetic Epidemiology, University of Münster, Münster, Germany
,
A. Torge
6   Institute of Clinical Chemistry, University Hospital Kiel-Lübeck, Kiel, Germany
,
V. Ganesan
2   Institute of Child Health, Developmental Neurosciences Programme, Southampton, United Kingdom
,
M. Prengler
2   Institute of Child Health, Developmental Neurosciences Programme, Southampton, United Kingdom
,
U. Nowak-Göttl
6   Institute of Clinical Chemistry, University Hospital Kiel-Lübeck, Kiel, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2019 (online)

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Objective: Risk factors for arterial ischemic stroke (AIS) in children are multiple and include cardiac disease, vasculopathy, and prothrombotic risk factors (PR). The relevance of these factors to a second AIS event is incompletely understood.

Methods: We conducted a multicenter cohort study to assess the rate of symptomatic stroke recurrence following initial AIS, pooling data on recurrent AIS from the databases held in Canada, Germany, and UK. We followed 894 patients aged 1 month to 18 years (median 6 years) at initial AIS for median 35 months.

Results: 160 of 894 patients (17.9%) had recurrence from 1 day to 136 months (median 3.1 months) after first AIS. Recurrence was significantly more common in children with (hazard ratio (HR) 2.5, 95% confidence intervals (CI) 1.92–3.5, p < 0.001) compared with children without vasculopathy. After adjusting for vasculopathy, antithrombin deficiency, elevated lipoprotein (a), and the presence of any combined PR were independently associated with recurrence. Recurrence rates calculated per 100 person-years were 10 (95%CI: 3–24) for antithrombin deficiency, 6 (95%CI 4–9) for elevated Lp(a), and 13 (95%CI 7–20) for combined PR.

Conclusions: Identifying children at increased for recurrent AIS events is important in intensifying preventative measures. Among 894 Canadian, English and German pediatric stroke patients, 17.9% experienced recurrent AIS at a median of 3.1 months after the index stroke. The presence of more than one prothrombotic risk factor is associated with AIS recurrence in children