Abstract Number: PB1304
Meeting: ISTH 2020 Congress
Background: FCA predominates among vascular causes of pediatric ischemic arterial stroke (AIS). Acute anticoagulation treatment and early initiation of low dose aspirin appear to reduce progression of the vaso-occlusive process and recurrence of ischemic episodes; the duration of antiplatelet secondary prevention is suggested for at least 2 years. To date there are no clinical studies on safety of antiplatelet therapy in children.
Aims: Analyze the etiology, choice and timing of diagnostic investigations, treatments, complications and outcome of patients with FCA observed at Gaslini Institute.
Methods: A retrospective observational study of pediatric patients with AIS secondary to FCA/isolated FCA selected according to CASCADE criteria from January 2005 to December 2019. We analyzed the index episode, neuroradiological evolution, clinical outcome (Pediatric Stroke Outcome Measure score, cognitive level, executive functions) and therapy used (acute phase, prophylaxis, etiological).
Results: 154 children with AIS and vasculopathy were enrolled of whom 33 were classified as AIS post-FCA/isolated FCA. Median follow-up was 2.3 years. In 17/33 cases an infectious etiology was recognized, particularly Varicella. All patients underwent Magnetic Resonance Angiography, 7 patients required diagnostic angiography. Vascular stenosis persisted after 6 months from onset in 71% of 31 cases with adequate follow-up. Four cases of arteriopathy relapse were observed in patients with previously unrecognized PVA. The outcome shows moderate impact of neurological deficit, headache, impaired cognitive and executive functions. A wide variety in approach to antithrombotic therapy was seen (Table 1). Compliance was excellent with antiplatelet therapy which was safe without major adverse events. Recurrence of clinical ischemic event occurred in 2 patients (Figure 1).
Conclusions: Improving neuroimaging by applying a score able to monitor arterial disease over time could be useful. It may be appropriate to extend antiplatelet prophylaxis beyond 2 years in PVA. Despite a small sample size, our study provides important insights for better management of FCA in pediatrics.
|Antithrombotic therapy||Number/Total (%)|
|Acute therapy:||28/33 (84.8 %)|
|Heparin followed by aspirin/other antiplatelet drug||14/28 (50 %)|
|Directly Aspirin||10/28 (35.7 %)|
|Other additional therapy (thrombectomy)||3/28 (10,7 %)|
|Antiplatelet prophylaxis:||33/33 (100 %)|
|Single antiplatelet (only Aspirin)||29/33 (87.9 %)|
|Double antiplatelet (Aspirin + Clopidogrel)||1/33 (3 %)|
|Switch from Aspirin to Clopidogrel||3/33 (9.1 %)|
|Duration antiplatelet prophylaxis (months) [N=33]||24 (0,5 – 175,2) Median (min – max)|
To cite this abstract in AMA style:Beccaria A, Svahn EJ, Bertamino M, Severino M, Pistorio A, Banov L, Molinari AC. Clinical and Radiological Outcome in a Single Center Cohort of Pediatric Patients with Focal Cerebral Arteriopathy (FCA). Safety of Antithrombotic Prophylaxis and Therapy [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/clinical-and-radiological-outcome-in-a-single-center-cohort-of-pediatric-patients-with-focal-cerebral-arteriopathy-fca-safety-of-antithrombotic-prophylaxis-and-therapy/. Accessed May 6, 2021.
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