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Abstract
Children often are treated with antiplatelet agents and anticoagulants, and sometimes they are given thrombolytic agents. Without age-specific clinical trials of these agents, we must try to extrapolate from adult stroke trials or from our clinical experience with adults. Heparin, followed by warfarin, is often given to children with sinovenous thrombosis or arterial dissection. Long-term anticoagulation for children with coagulopathy or a high risk of embolism caused by cardiac disease is sensible. Aspirin is used more than other antiplatelet agents in children. Often, it is started empirically in children with an ill-defined but probably substantial risk of additional ischemic stroke. Although it might be reasonable to try a thrombolytic agent in a child with an acute infarction, children tend to present too late. The Stroke Prevention Trial in Sickle Cell Anemia established that periodic blood transfusions reduce the risk of cerebral infarction in children with sickle cell disease and that transcranial Doppler can identify the children at greatest risk of stroke. Additional clinical trials are needed to determine the safety and effectiveness of various drugs in children.
Published Version
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