Anticoagulation in childhood-onset arterial ischemic stroke with non-moyamoya arteriopathy: findings from the Colorado and German (COAG) collaboration.
OBJECTIVE
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.
Bernard
Timothy J
TJ
Pediatric Neurology, B155, The Children's Hospital, Denver, 13123 East 16th Avenue, Aurora, CO 80045, USA. timothy.bernard@uchsc.edu
Goldenberg
Neil A
NA
Tripputi
Mark
M
Manco-Johnson
Marilyn J
MJ
Niederstadt
Thomas
T
Nowak-Göttl
Ulrike
U
D000293:Adolescent; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003120:Colorado; D005858:Germany; D006801:Humans; D007223:Infant; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D012189:Retrospective Studies
D000925:Anticoagulants