Aspirin versus low-dose low-molecular-weight heparin: Antithrombotic therapy in pediatric ischemic stroke patients - A prospective follow-up study

Background and Purpose-We sought to compare different antithrombotic second ary treatments (mainly medium-dose aspirin with low-dose low-molecular-weig ht heparin [LMWH]) in pediatric patients with a first ischenfic stroke onse t with regard to the risk of stroke recurrence. Methods-The population comprised 135 consecutively recruited children aged greater than or equal to6 months to less than or equal to 18 years with a F irst episode of ischemic stroke (idiopathic, n=79; cardiac, n= 15; vascular , n=30; infectious, n= 11). The stroke patients enrolled received prophylac tic antithrombotic therapy (aspirin, n=49, LMWH, n=86) in a nonrandomized f ashion and were prospectively followed up for a median (range) of 36 (8 to 48) months. The study end point was recurrent stroke. Results-Recurrent ischemic stroke was diagnosed at a median (range) of 5 (2 to 13) months after the first stroke onset in 13 of the 135 children (9.6% ) receiving antithrombotic therapy. In the majority of cases (84.6%) tile s ame vascular territory was involved. No significant difference was found wi th respect to the antithrombotic medication used (P=0.76, Fisher's exact te st). No major drug-related side effects were observed. Conclusions-This prospective multicenter follow-up study has provided evide nce that low-dose LMWH is not superior to aspirin and vice versa in prevent ing recurrent stroke in white pediatric stroke patients. However, further a dequately sized randomized trials are required to obtain reliable informati on on safety and efficacy with respect to the antithrombotic medications us ed.