Recurrent stroke: The role of thrombophilia in a large international pediatric stroke population

Gabrielle Deveber, Fenella Kirkham, Kelsey Shannon, Leonardo Brandão, Ronald Sträter, Gili Kenet, Hartmut Clausnizer, Mahendranath Moharir, Martina Kausch, Rand Askalan, Daune Macgregor, Monika Stoll, Antje Torge, Nomazulu Dlamini, Vijeja Ganesan, Mara Prengler, Jaspal Singh, Ulrike Nowak-Göttl

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1676-1681
Number of pages6
JournalHaematologica
Volume104
Issue number8
DOIs
StatePublished - 31 Jul 2019
Externally publishedYes

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