ABSTRACT
BACKGROUND AND PURPOSE: We sought to compare different antithrombotic secondary treatments (mainly medium-dose aspirin with low-dose low-molecular-weight heparin [LMWH]) in pediatric patients with a first ischemic stroke onset with regard to the risk of stroke recurrence. METHODS: The population comprised 135 consecutively recruited children aged >/=6 months to =18 years with a first episode of ischemic stroke (idiopathic, n=79; cardiac, n=15; vascular, n=30; infectious, n=11). The stroke patients enrolled received prophylactic antithrombotic therapy (aspirin, n=49; LMWH, n=86) in a nonrandomized fashion and were prospectively followed up for a median (range) of 36 (8 to 48) months. The study end point was recurrent stroke. RESULTS: Recurrent ischemic stroke was diagnosed at a median (range) of 5 (2 to 13) months after the first stroke onset in 13 of the 135 children (9.6%) receiving antithrombotic therapy. In the majority of cases (84.6%) the same vascular territory was involved. No significant difference was found with respect to the antithrombotic medication used (P=0.76, Fisher's exact test). No major drug-related side effects were observed. CONCLUSIONS: This prospective multicenter follow-up study has provided evidence that low-dose LMWH is not superior to aspirin and vice versa in preventing recurrent stroke in white pediatric stroke patients. However, further adequately sized randomized trials are required to obtain reliable information on safety and efficacy with respect to the antithrombotic medications used.
Subject(s)
Aspirin/therapeutic use , Brain Ischemia/drug therapy , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Stroke/drug therapy , Adolescent , Aspirin/adverse effects , Child , Child, Preschool , Fibrinolytic Agents/adverse effects , Follow-Up Studies , Heparin, Low-Molecular-Weight/administration & dosage , Heparin, Low-Molecular-Weight/adverse effects , Humans , Infant , Recurrence , Risk Factors , Stroke/classification , Stroke/mortality , Time FactorsABSTRACT
OBJECTIVES: To investigate the relationship between an insertion/deletion (4G/5G) polymorphism of the plasminogen activator inhibitor (PAI)-1 gene and childhood patients with a past history of ischemic stroke. METHODS: The PAI-1 4G/4G genotype and the coinheritance with lipoprotein (Lp) (a) levels, the factor V (FV) G1691A mutation, the prothrombin (PT) G20210A variant, and the methylene-tetrahydrofolate reductase (MTHFR) T677T genotype were studied in 198 Caucasian children with stroke and 951 controls (same age, sex and ethnical distribution). In a randomly selected subgroup of patients/controls (n=60) PAI-I activities have been investigated. RESULTS: The distribution of the 4G/5G genotypes was no different in childhood stroke patients and controls, with a 4G allele frequency of 55.8% in patients compared with 53.8% in control subjects (P=0.49). The 4G/4G genotype compared with the remaining genotypes was present in 43 cases and 167 (17.6% vs. 21.7%; OR/CI: 1.30/0.89-1.98; P=0.3). PAI-1 activity was significantly elevated (P < 0.001) in the patient group. CONCLUSIONS: Data presented here suggest that the 4G/4G genotype is not a major risk factor in the aetiology of childhood ischemic stroke.