Antithrombotic drug treatment of pediatric patients with ischemic stroke.
Causes of stroke in children include congenital heart malformations, sickle cell disease, infections, and metabolic disorders. Up to 80% of children with ischemic stroke have cerebrovascular disease, and case control studies demonstrate an association of ischemic stroke in children with hereditary prothrombotic risk factors. There have been no randomized, clinical trials for primary prevention, short-term treatment, or secondary prevention of pediatric ischemic stroke. Treatment recommendations are based on small case series or case reports, and have mainly been adapted from adult stroke studies. Antiplatelet agents (e.g. aspirin [acetylsalicylic acid]) and heparins (e.g. low molecular weight heparin), have been used on an individual patient basis. Warfarin is administered in children with cardioembolic stroke, arterial dissection, or persistent hypercoagulable states. Alteplase has been used in a few patients within 3 hours of the onset of symptoms. In each patient treated the benefit of anticoagulation has to be weighed up against the individual bleeding risk.
Nowak-Göttl
Ulrike
U
Department of Paediatric Haematology and Oncology, University Paediatric Hospital, University of Münster, Albert-Schweitzer-Strasse 3, 48149 Münster, Germany. leagottl@uni-muenster.de
Sträeter
Ronald
R
Sébire
Guillaume
G
Kirkham
Fenella
F
D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D010959:Tissue Plasminogen Activator