Ischemic stroke in children: Secondary prevention
- Sabrina E Smith, MD, PhD
Sabrina E Smith, MD, PhD
- Pediatric Neurologist
- Kaiser Permanente Oakland Medical Center
- Christine Fox, MD, MAS
Christine Fox, MD, MAS
- Assistant Professor of Neurology
- University of California, San Francisco
- Section Editors
- Scott E Kasner, MD
Scott E Kasner, MD
- Section Editor — Stroke
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
While more common in older adults, stroke also occurs in neonates, infants, children, and young adults, resulting in significant morbidity and mortality.
An overview of the secondary prevention of arterial ischemic stroke in children one month of age or older is provided here. Other aspects of ischemic stroke in children and young adults are reviewed elsewhere. (See "Ischemic stroke in children and young adults: Etiology and clinical features" and "Ischemic stroke in children: Evaluation, initial management, and prognosis".)
Stroke in neonates is discussed separately. (See "Stroke in the newborn: Classification, manifestations, and diagnosis".)
Stroke due to cerebral venous sinus thrombosis is also reviewed elsewhere. (See "Etiology, clinical features, and diagnosis of cerebral venous thrombosis".)
As with acute treatment, there are no controlled trials or studies examining the effectiveness of specific treatments for the secondary prevention of arterial ischemic stroke in children. Thus, the recommendations for children that follow are based mainly upon extrapolation from studies involving adults, and the clinical experience of experts, as reflected in consensus guidelines [1-4].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Paediatric Stroke Working Group. Stroke in childhood: Clinical guidelines for diagnosis, management and rehabilitation. 2004. https://www.rcplondon.ac.uk/sites/default/files/documents/stroke-in-childhood-guideline.pdf (Accessed on October 26, 2014).
- Roach ES, Golomb MR, Adams R, et al. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 2008; 39:2644.
- Monagle P, Chan AK, Goldenberg NA, et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e737S.
- Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160.
- Soman T, Rafay MF, Hune S, et al. The risks and safety of clopidogrel in pediatric arterial ischemic stroke. Stroke 2006; 37:1120.
- Schrör K. Aspirin and Reye syndrome: a review of the evidence. Paediatr Drugs 2007; 9:195.
- Bernard TJ, Goldenberg NA, Tripputi M, et al. Anticoagulation in childhood-onset arterial ischemic stroke with non-moyamoya arteriopathy: findings from the Colorado and German (COAG) collaboration. Stroke 2009; 40:2869.
- Adams RJ, McKie VC, Hsu L, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 1998; 339:5.
- Ware RE, Davis BR, Schultz WH, et al. Hydroxycarbamide versus chronic transfusion for maintenance of transcranial doppler flow velocities in children with sickle cell anaemia-TCD With Transfusions Changing to Hydroxyurea (TWiTCH): a multicentre, open-label, phase 3, non-inferiority trial. Lancet 2016; 387:661.
- Ay H, Benner T, Arsava EM, et al. A computerized algorithm for etiologic classification of ischemic stroke: the Causative Classification of Stroke System. Stroke 2007; 38:2979.
- Giglia TM, Massicotte MP, Tweddell JS, et al. Prevention and treatment of thrombosis in pediatric and congenital heart disease: a scientific statement from the American Heart Association. Circulation 2013; 128:2622.
- SECONDARY PREVENTION
- Risk factor reduction in children
- Cardioembolic stroke
- Arterial dissection
- Noninflammatory vasculopathy
- Sickle cell disease
- Hypercoagulable state
- Cryptogenic stroke
- Recurrent ischemia despite aspirin
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS