Increased anticardiolipin antibody IgG titers do not predict recurrent stroke or TIA in children.
BACKGROUND
Increased anticardiolipin antibody (ACLA) immunoglobulin (Ig) G titers are commonly found in children with arterial ischemic stroke (AIS) or TIA (AIS/TIA). The associated risk of recurrent thromboembolism is unknown.


OBJECTIVE
To determine the risk of recurrent thromboembolism associated with persistently increased ACLA titers of the IgG isotype in children with AIS/TIA.


METHODS
The authors studied a cohort of children surviving first AIS/TIA tested by standardized ELISA for beta2-glycoprotein I-dependent ACLA of the IgG isotype. Children with ACLA titers >15 IgG phospholipid (GPL) units (per manufacturer's cutoff point) on more than two occasions > or =6 weeks apart were classified as ACLA-positive (ACLA+) and compared with ACLA-negative (ACLA-) children with respect to recurrent thromboembolic events (AIS/TIA, sinovenous thrombosis, and extracerebral thromboembolism).


RESULTS
The authors recruited 34 ACLA+ children and 151 ACLA- children. Most ACLA+ children (30/34; 88%) had ACLA titers < or =40 GPL units. During the follow-up period (median duration, 2.8 years for ACLA+ children and 3.0 years for ACLA- children), AIS/TIA recurred in 26% of ACLA+ children and in 38% of ACLA- children; none developed sinovenous thrombosis or extracerebral thromboembolism. Based on survival analysis, this difference was nonsignificant (p = 0.54). Using binary partition evaluation, no titer criteria for ACLA positivity (range, 0 to 60 GPL units) predicted recurrent AIS/TIA.


CONCLUSIONS
In children surviving arterial ischemic stroke/TIA, increased anticardiolipin antibody immunoglobulin G titers do not predict recurrent thromboembolism.
Lanthier
S
S
Cerebrovascular Disease Centre, Division of Neurology, Department of Medicine, Centre hospitalier de l'Université de Montréal and Montreal Heart Institute, Quebec, Canada. sylvain.lanthier.chum@ssss.gouv.qc.ca
Kirkham
F J
FJ
Mitchell
L G
LG
Laxer
R M
RM
Atenafu
E
E
Male
C
C
Prengler
M
M
Domi
T
T
Chan
A K C
AK
Liesner
R
R
deVeber
G
G
D017153:Antibodies, Anticardiolipin / Q000097:blood*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000276:immunology; D002545:Brain Ischemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D018572:Disease-Free Survival; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D002546:Ischemic Attack, Transient / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D015993:Life Tables; D008131:London / Q000453:epidemiology; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D016019:Survival Analysis; D019851:Thrombophilia / Q000097:blood / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology
D017153:Antibodies, Anticardiolipin; D005343:Fibrinolytic Agents; D007074:Immunoglobulin G; D010975:Platelet Aggregation Inhibitors