Arteriopathy, D-Dimer, and risk of poor neurologic outcome in childhood-onset arterial ischemic stroke

Neil A. Goldenberg, Sarah Jenkins, Jessica Jack, Jennifer Armstrong-Wells, Laura Z. Fenton, Nicholas V. Stence, Joyce Oleszek, Richard Boada, Greta N. Wilkening, Charles Wilkinson, Jennifer B. Soep, Shelley D. Miyamoto, Lalit Bajaj, Peter M. Mourani, Marilyn J. Manco-Johnson, Timothy J. Bernard

Research output: Contribution to journalArticlepeer-review

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 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.

Original languageEnglish (US)
Pages (from-to)1041-1046.e1
JournalJournal of Pediatrics
Volume162
Issue number5
DOIs
StatePublished - May 2013

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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