TY - JOUR
T1 - Arteriopathy, D-Dimer, and risk of poor neurologic outcome in childhood-onset arterial ischemic stroke
AU - Goldenberg, Neil A.
AU - Jenkins, Sarah
AU - Jack, Jessica
AU - Armstrong-Wells, Jennifer
AU - Fenton, Laura Z.
AU - Stence, Nicholas V.
AU - Oleszek, Joyce
AU - Boada, Richard
AU - Wilkening, Greta N.
AU - Wilkinson, Charles
AU - Soep, Jennifer B.
AU - Miyamoto, Shelley D.
AU - Bajaj, Lalit
AU - Mourani, Peter M.
AU - Manco-Johnson, Marilyn J.
AU - Bernard, Timothy J.
N1 - Funding Information:
Supported by the National Institutes of Health , National Heart Lung, and Blood Institute ( 1K23HL084055 [to N.G.] and 1K23HL096895 [to T.B.]) and Centers for Disease Control and Prevention ( UR6/CCU820552 [to M.M.-J.]). The authors declare no conflicts of interest.
PY - 2013/5
Y1 - 2013/5
N2 - 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 postevent in children with arterial ischemic stroke (AIS). Study design: 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 postevent 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). Conclusion: 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.
AB - 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 postevent in children with arterial ischemic stroke (AIS). Study design: 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 postevent 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). Conclusion: 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.
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U2 - 10.1016/j.jpeds.2012.11.035
DO - 10.1016/j.jpeds.2012.11.035
M3 - Article
C2 - 23260102
AN - SCOPUS:84876686716
SN - 0022-3476
VL - 162
SP - 1041-1046.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 5
ER -