Pediatric stroke最新文献

{"title":"Prevalence of Antiplatelet and Anticoagulation Therapy in Children with Sickle Cell Anemia and Stroke.","authors":"Akhil Padarti, Charles T Quinn, Janet L Kwiatkowski, Melissa McNaull, Fenella J Kirkham, Patricia Plumb, Linda S Hynan, Michael Morgan Dowling","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sickle cell anemia (SCA) is a hemoglobinopathy resulting in both overt and silent strokes in the pediatric population. Multiple mechanisms including anemia, hypercoagulability, secondary moyamoya syndrome, paradoxical embolism, and platelet activation are implicated in the pathogenesis of stroke in SCA. Despite a paucity of literature on the safety or efficacy of antithrombotic therapies, these agents are used in patients with SCA for primary and secondary stroke prevention. This study examined the prevalence of antithrombotic usage in the SCA-Stroke arm of the Patent Foramen Ovale and Stroke (PFAST) study cohort. Approximately 46.5% (72/155) of patients report using antithrombotic medications. The frequency of antithrombotic medications increased with recurrent strokes: 39.6% (42/106) of patients were on antithrombotic medications after a single stroke, while 61.2% (30/49) of patients were on medications after a recurrent stroke. Within this population, 42.6% (66/155) were on antiplatelet medications, and only 4.5% (7/155) were on anticoagulants. Factors significantly associated with increased usage of antithrombotic therapy were the absence acute chest syndrome and higher baseline hemoglobin concentrations. While the majority of patients were taking antithrombotic therapies for secondary stroke prevention, a minority of patients were taking medications for other indications such as headache prophylaxis and prior venous sinus thrombosis. Given these current clinical practice patterns and prevalent use, further research is needed to define the role of antithrombotic agents in pediatric SCA. There appears to be clinical equipoise for the use of these agents in the SCA and pediatric stroke population.</p>","PeriodicalId":520526,"journal":{"name":"Pediatric stroke","volume":"11 ","pages":"111-140"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Plasma Inflammatory Proteins and Intracerebral Hemorrhage in Pediatric Brain Arteriovenous Malformations.","authors":"Shweta A Chawla, Shantel Weinsheimer, Jeffrey Nelson, Charles E McCulloch, Ethan Winkler, Nalin Gupta, Daniel Cooke, Steven Hetts, Yi Li, Christine K Fox, Heather J Fullerton, Helen Kim","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Brain arteriovenous malformations (bAVMs) are the leading cause of intracerebral hemorrhage (ICH) in children. Prior studies have implicated inflammation as a major contributor to bAVM pathogenesis and rupture, with increased inflammatory cell infiltration and interleukin protein levels reported in bAVM tissue. However, few studies have evaluated circulating inflammatory proteins as potential biomarkers for ICH in children with bAVMs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;Plasma levels of inflammatory markers differ in pediatric patients with ruptured bAVMs compared to unruptured bAVMs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study included children with bAVMs (&lt; 19 years old at presentation) evaluated at our institution between 2005 and 2022, who were enrolled in a prospective cohort study. Plasma samples (n = 52) were collected after diagnosis but before treatment and analyzed using a commercially available, comprehensive multiplex panel of 384 inflammatory markers. To control for confounders, such as the acute response to ICH, we performed segmented multivariable linear regression analysis, which allows initial protein levels to vary but assumes slopes to be constant within groups after a specified time point (e.g., 32 days). The model adjusted for age, sex, time to blood collection, and interaction of time with ICH status to identify plasma proteins associated with ICH. Exponentiated coefficients are presented and interpreted as proportional increases (PIs). We report nominally associated (p ≤ 0.05) and significantly associated proteins based on Bonferroni adjustment (p = 0.05/368 proteins = 0.00014).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We analyzed blood samples collected prior to treatment in 27 unruptured bAVMs (non-ICH cases) and 25 ruptured bAVMs. The median time from study enrollment to sample collection was 126 days (IQR = 64-247) for non-ICH cases and 11 days (IQR = 4-37) for ICH cases. We observed four different patterns of association of biomarker levels with ICH status:1) no differences between ICH and non-ICH groups over time (n=306 markers); 2) no long-term differences between ICH and non-ICH groups but initial trajectories differ after presentation (n=29); 3) long-term differences between ICH and non-ICH groups and initial trajectories differ after presentation (n=5); and 4) consistent differences between ICH and non-ICH groups over time (n=28). Thus, 33 inflammatory proteins were nominally associated (p &lt; 0.05) with ICH either with or without initial trajectory differences (patterns 3 or 4, PI ranging from 0.71 to 4.23). Five of these 33 proteins have been associated with bAVM development and rupture in previous studies (VEGFA, MMP-10, TNF, ANGPTL2, and CSF1). No proteins were statistically significant after adjustment for multiple testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We measured a large set of inflammatory proteins in blood samples from pediatric bAVM patients and identified 33 pro","PeriodicalId":520526,"journal":{"name":"Pediatric stroke","volume":"12 ","pages":"1-40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12662739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}