Antithrombotic Therapy Prevents Recurrent Stroke in Children with Bacterial Meningitis

F. Bruder Stapleton, MD

Heparin was more effective than aspirin.

Bacterial meningitis, although declining in incidence, continues to cause serious morbidity, including ischemic stroke. In a retrospective review of the Canadian Pediatric Ischemic Stroke Registry, researchers assessed the efficacy of antithrombotic therapy in preventing recurrent ischemic stroke in children with bacterial meningitis.

The study cohort comprised 22 children (median age, 13 months; age range, 35 days–17.5 years; 64% boys) with bacterial meningitis who developed ischemic stroke (at a median of 3 days after first symptoms of infection). All patients had undergone ≥2 neuroimaging studies at one of two children's hospitals. Bacterial agents included Streptococcus pneumoniae (10 patients), S. agalactiae (4), Mycobacterium tuberculosis (3), Neisseria meningitidis (1), Fusobacterium sp. (1), and unidentified (3). No preexisting prothrombotic conditions were identified.

Following initial or recurrent ischemic stroke, 6 children were treated with heparin (2 after initial stroke) and 10 were treated with acetylsalicylic acid (ASA; 6 after initial stroke). Neither of the 2 children who initially received heparin had recurrent stroke whereas 3 of 6 children who initially received ASA had further ischemic injury. Heparin therapy was initiated in 2 of the ASA-treated patients after stroke recurrence, and no subsequent ischemic injury occurred. In all, 4 of 10 patients treated with ASA experienced recurrence. Eight of the 14 patients (57%) who did not receive antithrombotic therapy had recurrent stroke. None of the children receiving heparin or ASA had intracranial hemorrhage.

Citation(s):

Boelman C et al. Antithrombotic therapy for secondary stroke prevention in bacterial meningitis in children. J Pediatr 2014 Jul 22; [e-pub ahead of print].