Abstract Details

Title Use of anticoagulation does not increase hemorrhagic transformation following cardioembolic stroke in childhood

Topic Child Neurology and Developmental Neurology

Presentation(s) P12 - Poster Session 12 (12:00 PM-1:00 PM)

Poster/Presentation
Number 5-015

Objective To determine the incidence and risk period of hemorrhagic transformation in cardioembolic stroke in childhood in relation to the use of anticoagulation.

Background A common urgent clinical question in pediatric stroke is when anticoagulation can be safely undertaken following cardioembolic stroke. Given increased risk of hemorrhage in adults with cardioembolic stroke, waiting 4-14 days to start anticoagulation is recommended. However, in children where the risk of hemorrhage is less clear, delayed anticoagulation could lead to inadequate anticoagulation for secondary stroke prevention and/or delays in procedures requiring anticoagulation.

Design/Methods We identified 67 cases of pediatric arterial ischemic stroke (onset at age 1 month-18 years) with a cardiac etiology at our institution between 1/1/2009 and 1/1/2019 for retrospective chart and neuroimaging review. Chi-square test was used for statistical analysis, with p-value >0.05 considered statistically significant.

Results Hemorrhagic transformation (HT) occurred in 11 of 67 cases (16%). There were 11 additional cases that were originally identified as HT on chart review but determined on long-term neuroimaging review to have been misidentified (eg. calcification, laminar necrosis, or embolus). There was no significant difference in HT between patients who were and were not anticoagulated prior to their stroke (19% vs. 16%). Furthermore, among patients anticoagulated prior to their stroke, there was no significant difference in HT between those who had their anticoagulation decreased and those who had their anticoagulation continued (21% vs. 18%). Most HT (73%) occurred in the first two days after stroke.

Conclusions The incidence of hemorrhagic transformation after pediatric cardioembolic stroke was 16%, which was not increased with the use of anticoagulation, and which was lower than initially believed as long-term neuroimaging distinguished true hemorrhagic transformation from mimics. Most hemorrhagic transformations occurred early, suggesting a decreased risk beyond the first two days following stroke diagnosis, regardless of anticoagulation therapy.

Authors/Disclosures
Pin-Yi Ko, MD PRESENTER	No disclosure on file
	No disclosure on file
Mark Wainwright, MD, PhD, FAAN (Division of Neurology Seattle Childrens Hospital)	Dr. Wainwright has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sage Therapeutics.
Catherine M. Amlie-Lefond, MD, FAAN (Seattle Childrens Hospital)	Dr. Amlie-Lefond has nothing to disclose.

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