PITTSBURGH — Anticoagulant therapy is appropriate for children with arterial ischemic stroke, since the rate of intracranial hemorrhage in treated patients is low, Dr. Adam Kirton said in a poster presented at the annual meeting of the Child Neurology Society.
“Our study suggests that intracranial hemorrhage in children with arterial stroke treated with anticoagulation is infrequent and usually very mild in severity,” Dr. Kirton said in an interview.
“The findings add important safety data to support current consensus guidelines recommending the use of anticoagulation in children with stroke.”
His study, carried out in collaboration with the thrombosis program at the Hospital for Sick Children in Toronto, included 126 children younger than 18 years who were treated with anticoagulation therapy for acute arterial ischemic stroke.
Sixteen patients (13%) experienced intracranial hemorrhage, said Dr. Kirton, of the Children's Stroke Program at the Hospital for Sick Children in Toronto. All of the bleeds occurred within 24 days of the stroke diagnosis, with a mean time to bleed of 11 days (range 2–24 days). “This suggests a fixed period of vulnerability,” Dr. Kirton said.
Most of the bleeds (10) were asymptomatic. In the six symptomatic bleeds, symptoms were irritability (three), headache and vomiting (one), loss of consciousness (one), and dysarthria (one).
Treatment regimens in patients with bleeding included low-molecularweight heparin (five patients); unfractionated heparin (four); warfarin alone (one); warfarin plus low-molecular-weight heparin (two); warfarin plus unfractionated heparin (two); low-molecular- weight heparin plus aspirin (one); and unfractionated heparin plus aspirin (one).
Three of the children with bleeds died—two from cardiac causes and one who had preexisting promyelocytic leukemia.
Congenital heart disease significantly increased the risk of an intracranial bleed on anticoagulant therapy.
Bleeds occurred in 26% of the 38 children with congenital heart disease, but in only 7% of those without it.
A larger study of intracranial bleeding in pediatric stroke comparing treated with untreated patients will help confirm the spontaneous occurrence of bleeding and further support the safety of this important therapy.