Abstract W MP110: Stimulant Medications as a Risk Factor for Childhood Stroke

Abstract

Background: The association of stimulants and stroke in adults has raised concerns about attention deficit hyperactivity disorder (ADHD) medications prescribed to children. A large retrospective cohort study found no increased risk for serious cardiovascular events but was limited in how stroke was identified. We examined the association between stimulant medications and stroke in a case-control study with cases rigorously detected. Methods: This study was nested in a cohort of 2.5 million children (<20y) enrolled in a large integrated health care plan, 1993-2007. Cases of hemorrhagic and ischemic stroke at ≥2 years of age were identified from searches of radiology reports in addition to diagnostic codes, and confirmed through independent chart review; 4 controls per case were randomly selected, matched by age, year of enrollment and primary care facility. The cohort was linked to electronic pharmaceutical records to collect data on ADHD medications prior to stroke (index date for controls). Analyses using conditional logistic regression focused on current use (at time of event), use within the past 6 months (at least 2 sequential prescriptions), and ever use. Length of most recent continuous exposure was compared between groups. Our study was powered to detect an OR as low as 4.4 for current exposure and 3.7 for 6-month exposure. Results: We identified 258 cases and 1030 controls. No measured exposures significantly differed between the two groups in adjusted analyses (Table). The median (IQR) length of continuous exposure for those using stimulants within the prior 6 months was 322 days (100, 187) for cases and 377 days (198, 821) for controls (p=0.10). Conclusions: No significant associations were found between stroke and use of ADHD stimulants in this study rigorously identifying pediatric stroke outcomes over a 14-year period. The OR for current use was similar to that found in a large cohort study.