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3808 Recurrent Stroke: The Role of Thrombophilia in a Large International Pediatric Stroke Population

Program: Oral and Poster Abstracts
Session: 331. Pathophysiology of Thrombosis: Poster III
Hematology Disease Topics & Pathways:
Diseases, Bleeding and clotting, Thrombosis, Clinically relevant
Monday, December 3, 2018, 6:00 PM-8:00 PM
Hall GH (San Diego Convention Center)

Gabrielle Deveber, MD, MSc1*, Fenella Jane Kirkham, MD2*, Kelsey Shannon1*, Leonardo R. Brandao, MD, MSc3, Ronald Sträter4*, Gili Kenet, MD5, Hartmut Clausnizer6*, Mahendranath Moharir7*, Martina Kausch6*, Rand Askalan8*, Daune MacGregor9*, Monika Stoll10*, Antje Torge6*, Nomazulu Dlamini9*, Vijeya Ganesan11*, Mara Prengler11*, Jaspal Singh12* and Ulrike Nowak Goettl13*

1The Hospital for Sick Children, Toronto, ON, Canada
2Developmental Neurosciences, UCL Institute of Child Health, London, United Kingdom
3Paediatric Haemotology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
4Department of Pediatric Hematology/Oncology, University of Münster, Münster, Germany
5Sheba Medical Center, Tel Hashomer, Israel
6Institute of Clinical Chemistry, University Hospital Kiel-Lübeck, Lübeck, Germany
7Department of Paediatrics, Division fo Neurology, The Hospital for Sick Children, Toronto, ON, Canada
8University of Toronto, Toronto, ON, Canada
9Department of Paediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
10Westfaelische Wilhelms-University Muenster, Muenster, DEU
11Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
12University hospital Southampton, Southhampton, United Kingdom
13Institute of Clinical Chemistry, Univ. Hospital of Kiel & Lübeck, Kiel, Germany

OBJECTIVE:

Risk factors for arterial ischemic stroke (AIS) in children are multiple and include cardiac disease, vasculopathy, and prothrombotic risk factors (PR). The relevance of these factors to a second AIS event is incompletely understood.

METHODS:

We conducted a multicenter cohort study to assess the rate of symptomatic stroke recurrence following initial AIS, pooling data on recurrent AIS from the databases held in Canada, Germany, and UK. We followed 894 patients aged 1 month to 18 years (median 6 years) at initial AIS for median 35 months.

RESULTS:

160 of 894 patients (17.9%) had recurrence from 1 day to 136 months (median 3.1 months) after first AIS. Recurrence was significantly more common in children with (hazard ratio (HR) 2.5, 95% confidence intervals (CI) 1.92-3.5, p<0.001) compared to children without vasculopathy. After adjusting for vasculopathy, antithrombin deficiency, elevated lipoprotein (a), and the presence of any combined PR were independently associated with recurrence. Recurrence rates calculated per 100 person-years were 10 (95%CI: 3-24) for antithrombin deficiency, 6 (95%CI 4-9) for elevated Lp(a), and 13 (95%CI 7-20) for combined PR.

CONCLUSIONS:

Identifying children at increased for recurrent AIS events is important in intensifying preventative measures. Among 894 Canadian, English and German pediatric stroke patients, 17.9% experienced recurrent AIS at a median of 3.1 months after the index stroke. The presence of more than one prothrombotic risk factor is associated with AIS recurrence in children

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH