TY - JOUR
T1 - Recurrent stroke
T2 - The role of thrombophilia in a large international pediatric stroke population
AU - Deveber, Gabrielle
AU - Kirkham, Fenella
AU - Shannon, Kelsey
AU - Brandão, Leonardo
AU - Sträter, Ronald
AU - Kenet, Gili
AU - Clausnizer, Hartmut
AU - Moharir, Mahendranath
AU - Kausch, Martina
AU - Askalan, Rand
AU - Macgregor, Daune
AU - Stoll, Monika
AU - Torge, Antje
AU - Dlamini, Nomazulu
AU - Ganesan, Vijeja
AU - Prengler, Mara
AU - Singh, Jaspal
AU - Nowak-Göttl, Ulrike
N1 - Publisher Copyright:
© 2019 Ferrata Storti Foundation.
PY - 2019/7/31
Y1 - 2019/7/31
N2 - Risk factors for arterial ischemic stroke in children include vasculopathy and prothrombotic risk factors but their relative importance to recurrent stroke is uncertain. Data on recurrent stroke from databases held in Canada (Toronto), Germany (Kiel-Lübeck/Münster), and the UK (London/Southampton) were pooled. Data were available from 894 patients aged 1 month to 18 years at first stroke (median age, 6 years) with a median follow-up of 35 months. Among these 894 patients, 160 (17.9%) had a recurrence between 1 day and 136 months after the first stroke (medi-an, 3.1 months). Among 288 children with vasculopathy, recurrence was significantly more common [hazard ratio (HR) 2.5, 95% confidence interval (95% CI) 1.92-3.5] compared to the rate in children without vasculopathy. Adjusting for vasculopathy, isolated antithrombin deficiency (HR 3.9; 95% CI: 1.4-10.9), isolated elevated lipoprotein (a) (HR 2.3; 95% CI: 1.3-4.1), and the presence of more than one prothrombotic risk factor (HR 1.9; 95% CI: 1.12-3.2) were independently associated with an increased risk of recurrence. Recurrence rates calculated per 100 person-years were 10 (95% CI: 3-24) for antithrombin deficiency, 6 (95% CI: 4-9) for elevated lipoprotein (a), and 13 (95% CI: 7-20) for the presence of more than one prothrombotic risk factor. Identifying children at increased risk of a second stroke is important in order to intensify measures aimed at preventing such recurrences.
AB - Risk factors for arterial ischemic stroke in children include vasculopathy and prothrombotic risk factors but their relative importance to recurrent stroke is uncertain. Data on recurrent stroke from databases held in Canada (Toronto), Germany (Kiel-Lübeck/Münster), and the UK (London/Southampton) were pooled. Data were available from 894 patients aged 1 month to 18 years at first stroke (median age, 6 years) with a median follow-up of 35 months. Among these 894 patients, 160 (17.9%) had a recurrence between 1 day and 136 months after the first stroke (medi-an, 3.1 months). Among 288 children with vasculopathy, recurrence was significantly more common [hazard ratio (HR) 2.5, 95% confidence interval (95% CI) 1.92-3.5] compared to the rate in children without vasculopathy. Adjusting for vasculopathy, isolated antithrombin deficiency (HR 3.9; 95% CI: 1.4-10.9), isolated elevated lipoprotein (a) (HR 2.3; 95% CI: 1.3-4.1), and the presence of more than one prothrombotic risk factor (HR 1.9; 95% CI: 1.12-3.2) were independently associated with an increased risk of recurrence. Recurrence rates calculated per 100 person-years were 10 (95% CI: 3-24) for antithrombin deficiency, 6 (95% CI: 4-9) for elevated lipoprotein (a), and 13 (95% CI: 7-20) for the presence of more than one prothrombotic risk factor. Identifying children at increased risk of a second stroke is important in order to intensify measures aimed at preventing such recurrences.
UR - http://www.scopus.com/inward/record.url?scp=85070635077&partnerID=8YFLogxK
U2 - 10.3324/haematol.2018.211433
DO - 10.3324/haematol.2018.211433
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C2 - 30679327
AN - SCOPUS:85070635077
SN - 0390-6078
VL - 104
SP - 1676
EP - 1681
JO - Haematologica
JF - Haematologica
IS - 8
ER -
