USE OF CLOPIDOGREL IN PEDIATRIC ARTERIAL ISCHEMIC STROKE: SAFETY AND ADVERSE EFFECTS

Abstract

Objectives: Aspirin (ASA) is the main anti-platelet treatment for secondary prevention in children with Arterial Ischemic Stroke (AIS). Clopidogrel is an alternative anti-platelet medication for such children. Our study objective was to determine the tolerability and adverse effects of Clopidogrel in children with AIS. Methods: Consecutive cohort study of children aged 1 to 18 years with AIS and receiving Clopidogrel between January 2000 and June 2004 were included. Compliance, tolerability and side effects were assessed in all study children with review of Stroke clinic charts and hospital health records. Results: 16 children received Clopidogrel therapy: 8 children Clopidogrel alone and 8 in conjunction with ASA. Average length of treatment was 22 months. No children had recurrent stroke during Clopidogrel treatment. No major side effects were reported during Clopidogrel treatment alone. However, significant intracranial hemorrhage was reported in 2 patients (25%) on the ASA and Clopidogrel combination. One patient developed a significant subdural hematoma 6 weeks after revascularization surgery for moyamoya disease while receiving both Clopidogrel and Aspirin. Another patient also developed a subdural hematoma while on Aspirin and Clopidogrel. This patient had cerebral atrophy and hypertention due to Progeria. Both medications were put on hold and the patients recovered. Conclusion: Clopidogrel is a safe and well-tolerated alternative in children when used alone but should be used with caution when used in conjunction with ASA. Combination therapy maybe unsafe in children with stroke, particularly in the setting of diffuse vasculopathy and cerebral atrophy. Additional studies in larger numbers of children are needed to determine the true safety and the effectiveness of Clopidogrel.