title: Arteriopathy, D-dimer, and risk of poor neurologic outcome in childhood-onset arterial ischemic stroke.
abstract: OBJECTIVE
  To assess whether acute findings of cerebral arteriopathy, large infarct, and acutely elevated plasma D-dimer levels are independently prognostic of poor long-term neurologic outcome as measured at ≥ 1 year post-event in children with arterial ischemic stroke (AIS).
  
  
  METHODS
  Sixty-one patients with childhood-onset (ie, >28 days of life) AIS were enrolled in a single-institution cohort study at Children's Hospital Colorado between February 2006 and June 2011. Data on demographic and diagnostic characteristics, antithrombotic treatments, and outcomes were systematically collected.
  
  
  RESULTS
  Cerebral arteriopathy and D-dimer levels >500 ng/mL (a measure of coagulation activation) were identified acutely in 41% and 31% of the cohort, respectively. Anticoagulation was administered in the acute period post-event in 40% of the children, in the subacute period in 43%, and in the chronic period in 28%. When not receiving anticoagulation, patients were routinely treated with aspirin 2-5 mg/kg once daily for a minimum of 1 year. Death, major bleeding (including intracranial hemorrhage), and recurrent AIS were infrequent. The Pediatric Stroke Outcome Measure at 1 year demonstrated poor outcome in 54% of the children. Acute cerebral arteriopathy and elevated D-dimer level were identified as putative prognostic factors for poor outcome; after adjustment for D-dimer, arteriopathy was an independent prognostic indicator (OR, 19.0; 95% CI, 1.6-229.8; P = .02).
  
  
  CONCLUSIONS
  Arteriopathy and coagulation activation are highly prevalent in the acute period of childhood AIS. Although recurrent AIS and intracranial hemorrhage were infrequent in our cohort, one-half of children experienced a poor neurologic outcome at 1 year, the risk of which was increased by acute arteriopathy. Substantiation of these findings in multi-institutional cohort studies is warranted, toward risk stratification in childhood-onset AIS.
authors.affiliation: Division of Hematology, Departments of Pediatrics and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. neil.goldenberg@allkids.org
authors.forename: Neil A
authors.initials: NA
authors.lastname: Goldenberg
authors.forename: Sarah
authors.initials: S
authors.lastname: Jenkins
authors.forename: Jessica
authors.initials: J
authors.lastname: Jack
authors.forename: Jennifer
authors.initials: J
authors.lastname: Armstrong-Wells
authors.forename: Laura Z
authors.initials: LZ
authors.lastname: Fenton
authors.forename: Nicholas V
authors.initials: NV
authors.lastname: Stence
authors.forename: Joyce
authors.initials: J
authors.lastname: Oleszek
authors.forename: Richard
authors.initials: R
authors.lastname: Boada
authors.forename: Greta N
authors.initials: GN
authors.lastname: Wilkening
authors.forename: Charles
authors.initials: C
authors.lastname: Wilkinson
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Soep
authors.forename: Shelley D
authors.initials: SD
authors.lastname: Miyamoto
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mourani
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Manco-Johnson
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bernard
mesh_terms: D001778:Blood Coagulation Disorders / Q000150:complications / Q000453:epidemiology*; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D015331:Cohort Studies; D003120:Colorado; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D