Assessing risk factors for recurrent arterial ischemic stroke in childhood

Results of previous case-control studies have shown an association between ischemic stroke and hereditary prothrombotic risk factors: factor V G1691A and factor II G20210A mutations, raised lipoprotein, and deficiencies in antithrombin, protein C, and protein S. The relevance of these factors to a second ischemic stroke event is not known and was the key objective of this study.1 The risk of a second arterial ischemic stroke associated with these prothrombotic risk factors, with underlying diseases or stroke comorbidities, and with stroke subtypes (cardiac, vascular, infectious, idiopathic) was assessed.1167 boys and 134 girls aged between 6 months and 18 years of age (median 7 years) with a first episode of ischemic stroke were followed-up prospectively for a median of 44 months (range 20-56).The findings showed that recurrent ischemic stroke was diagnosed in 20 of 301 children who survived (6.6%) at a median of 5 months (range 1.5-36) after first stroke onset. The relative risk of having a second stroke was significantly increased in patients with raised lipoprotein (relative risk 4.4, 95% CI 1.9-10.5) and in children with familial protein C deficiency (3.5, 1.1-10.9).1Additionally, survival analysis showed that a first ischemic stroke of vascular origin was significantly associated with having a second stroke (odds ratio 3.9, 95% CI 1.4-10.6).1Overall, the study showed that raised lipoprotein, protein C deficiency, and stroke of vascular origin are risk factors for recurrent arterial ischemic stroke in childhood.Reference...