No abstract

Data from large case series of children with cerebral thrombotic events are pivotal to improve prevention, early recognition and treatment of these conditions. The Italian Registry of Pediatric Thrombosis (R. I. T. I.) was established in 2007 by a multidisciplinary team, aiming for a better understanding of neonatal and paediatric thrombotic events in Italy and providing a preliminary source of data for the future development of specific clinical trials and diagnostic-therapeutic protocols. We analysed data relative to the paediatric cerebral thrombotic events of the R. I. T. I. which occurred between January 2007 and June 2012. In the study period, 79 arterial ischaemic stroke (AIS) events (49 in males) and 91 cerebral sinovenous thrombosis (CSVT) events (65 in males) were enrolled in the R. I. T. I. Mean age at onset was 4.5 years in AIS, and 7.1 years in CSVT. Most common modes of presentation were hemiparesis, seizures and speech disturbances in AIS, and headache, seizures and lethargy in CSVT. Most common etiologies were underlying chronic diseases, vasculopathy and cardiopathy in AIS, and underlying chronic diseases and infection in CSVT. Time to diagnosis exceeded 24 hours in 46 % AIS and 59 % CSVT. Overall data from the Italian Registry are in substantial agreement with those from the literature, despite small differences. Among these, a longer time to diagnosis compared to other registries and case series poses the accent to the need of an earlier recognition of paediatric cerebrovascular events in Italy, in order to enable prompt and effective treatment strategies.

The aim of this study was to assess the prevalence of inherited thrombophilia in 'peri-neonatal arterial ischemic stroke' (AIS), and its possible correlation with type of stroke and long-term neurological outcome. A cohort of twenty-four infants affected by AIS were analysed for risk factors, clinical and neuroradiological features, coagulation and thrombophilia profile and outcome. Two subgroups were considered, based on clinical presentation: infants symptomatic in the neonatal period, acute AIS (aAIS) and those with a delayed presentation (presumed peri-neonatal onset, pAIS). The mean follow-up on patients was 3 yr and 1 month (range 1-15 yr). Inherited thrombophilia, consisting of factor V Leiden and prothrombin G20210A mutations, protein C and/or protein S deficiencies, was detected in 28.6%. A significantly higher prevalence of inherited thrombophilia was observed in infants with pAIS compared with aAIS (Fisher's exact test, P = 0.011). Infants with pAIS had a significantly worse neurological outcome with respect to aAIS (Fisher's exact test, P = 0.014). Inherited thrombophilia was significantly higher in patients with a poor neurological outcome (Fisher's exact test P = 0.002). Although the clinical presentation (aAIS vs. pAIS) was associated with future neurological disabilities, it is the thrombophilia but not the clinical presentation, which remains the only significant prognostic factor in the logistic regression analysis. Although preliminary, these data suggest an association of unfavourable neurological outcome and inherited prothrombotic defects in neonatal AIS. The higher prevalence of inherited thrombophilia identified in pAIS and the worse neurological outcome encourage further investigations in population-based studies.

The primary aim of this study was to describe the use of the antiplatelet agent clopidogrel in pediatric tertiary care hospitals and to evaluate how it has changed over time. This retrospective cohort study of pediatric inpatients from 2000 to 2009 used the Pediatric Health Information System database (PHIS) which contains data from 42 U.S. tertiary care children's hospitals. Pharmacy billing codes were used to identify hospital admissions during which clopidogrel was administered. Patient demographics and concurrent use of other anticoagulant and antiplatelet drugs were collected. The International Classification of Diseases, ninth edition (ICD-9) codes were used to categorize admissions by potential indications for antiplatelet drugs and to identify bleeding and thrombotic events. From 2001 to 2009, clopidogrel use increased 15-fold, from 6 to 89.5 per 100,000 admissions. Patients with cardiac disease accounted for the largest proportion (75%), followed by stroke (9.4%) and Kawasaki disease (6.1%). Among those with cardiac disease, hypoplastic left heart syndrome (38%) and pulmonary artery anomalies (37%) were the most common. Aspirin was used concurrently during 52% of the admissions, enoxaparin during 9%, and warfarin during 5%. The use of clopidogrel is increasing rapidly among children with cardiovascular diseases. This population has a high risk of bleeding, thrombosis, and mortality. It therefore is imperative that future studies continue to evaluate the safety and efficacy of clopidogrel for these children.

No abstract