The roles of anatomic factors, thrombophilia, and antithrombotic therapies in childhood-onset arterial ischemic stroke.
Childhood-onset arterial ischemic stroke (AIS) is a rare disorder with high risks of both recurrent stroke and life-long neurological morbidity. Anatomic risk factors for primary and/or recurrent AIS include a venous thrombotic source for paradoxical embolism via a patent foramen ovale, primary cardioembolism, extracranial dissection, and intracranial arteriopathies, among others. Genetic and acquired thrombophilias are common, some of which have been shown to have prognostic influence on risk of recurrent AIS. While knowledge of childhood AIS risk factors has grown considerably in recent years, an evidence-based understanding of optimal antithrombotic therapy strategies has not yet been attained. Consensus-based guidelines have been developed, but future research must emphasize identification of additional prognostic factors and the initiation of cooperative randomized controlled clinical trials.
Department of Pediatrics, Section of Child Neurology, Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado Denver and The Children's Hospital, Aurora, Colorado, USA. timothy.bernard@ucdenver.edu
Timothy J
TJ
Bernard
Marilyn J
MJ
Manco-Johnson
Neil A
NA
Goldenberg
D000293:Adolescent; D017668:Age of Onset; D002545:Brain Ischemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D002539:Cerebral Arterial Diseases / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D013923:Thromboembolism / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D019851:Thrombophilia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents