Place des antithrombotiques dans l’accident vasculaire cérébral de l’enfant

Abstract

Each year, 500 to 1000 children experience a stroke in France. Long-term follow-up demonstrates persistent neurologic deficit in most of them. Despite the lack of studies with high level of evidence, paediatric stroke guidelines are regularly updated based on observational data, analogy with recommendation for adults, and expert opinion. It is reasonable to initiate anticoagulation during the acute phase of cerebral sinovenous thrombosis in children; the duration of anticoagulation needs to be individually tailored. It is not yet possible to draw any conclusions regarding neonates. Intravenous or intra-arterial thrombolysis and mechanical devices have the potential to provide instant and safe recanalization under optimal circumstances, but no generalization about their efficacy in childhood ischemic stroke can be drawn. Aspirin is effective in reducing the risk of recurrence in children with arterial ischemic stroke. There is a need to develop new studies with easy for use of antithrombotic drugs, such as aspirin or oral direct factor Xa inhibitors. A specific approach for rare disease population, which follows guidance for the design and conduct of paediatric trials, is required.