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Available from: Therese M Giglia, Jan 22, 2015
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    ABSTRACT: Background Cardiac disease is a leading cause of stroke in children, yet limited data support the current stroke prevention and treatment recommendations. A multi-disciplinary panel of clinicians was convened in February 2014 by the International Pediatric Stroke Study group to identify knowledge gaps and prioritize clinical research efforts for children with cardiac disease and stroke. Results Significant knowledge gaps exist including a lack of data on stroke incidence, predictors, primary and secondary stroke prevention, hyperacute treatment and outcome in children with cardiac disease. Commonly used diagnostic techniques including brain CT and ultrasound have low rates of stroke detection and diagnosis is frequently delayed. The challenges of research studies in this population include epidemiological barriers to research such as small patient numbers, heterogeneity of cardiac disease, and co-existence of multiple risk factors. Based on stroke burden and study feasibility, studies involving mechanical circulatory support, single ventricle patients, early stroke detection strategies, and understanding secondary stroke risk factors and prevention are the highest research priorities over the next 5 to 10 years. The development of large-scale multi-center and multi-specialty collaborative research is a critical next step. The designation of centers of expertise will assist in clinical care and research. Conclusions There is an urgent need for additional research to improve the quality of evidence in guideline recommendations for cardiogenic stroke in children. While significant barriers to clinical research exist, multi-center and multi-specialty collaboration is an important step towards advancing clinical care and research for children with cardiac disease and stroke.
    Pediatric Neurology 01/2014; 52(1). DOI:10.1016/j.pediatrneurol.2014.09.016 · 1.50 Impact Factor
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    ABSTRACT: A scientific statement on the prevention and treatment of thrombosis in children with congenital heart disease has been published by Giglia et al. on behalf of the AHA. This paper adds substantially to the current literature, and yet highlights the major limitations in our current understanding and knowledge in this field.
    Nature Reviews Cardiology 01/2014; 11(3). DOI:10.1038/nrcardio.2013.217 · 10.15 Impact Factor
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    ABSTRACT: Objective: To describe antithrombin levels, altered unfractionated heparin effect (anti-factor Xa activity and activated partial thromboplastin time), and adverse effects post administration of a single high dose of antithrombin concentrate. Design: Retrospective review. Patients: Infants and children with antithrombin levels less than 50% and a subtherapeutic unfractionated heparin effect. Setting: Quaternary care children's hospital with a dedicated anticoagulation program. Interventions: None. Measurements and Main Results: A single high dose of antithrombin concentrate was administered. Antithrombin level, anti-factor Xa, and activated partial thromboplastin times were measured post antithrombin concentrate infusion and daily until stable. One hundred twenty-one patients received 246 doses of antithrombin. Patients were described using two cohorts based on the ability to obtain exact heparin doses. Cohort 1 included all patients between January 2004 and May 2008 when complete heparin dosing was unavailable. Cohort 2 included patients from May 2008 to May 2011 when heparin dose was available. Median age and weight were 3.7 months and 4.1 kg. Mean antithrombin concentrate dose was 222 IU/kg. Mean antithrombin level increased from 0.39 to 1.20 U/mL following antithrombin concentrate administration. In cohort 2, unfractionated heparin doses to achieve a target anti-factor Xa activity pre-post antithrombin concentrate were 28 and 19 U/kg/hr, respectively, for children 12 months old or younger and 25 and 19 U/kg/hr, respectively, for children older than 12 months. There were no hemorrhagic, thrombotic, or allergic events within 1 week of antithrombin concentrate administration. Conclusions: This is the largest study of antithrombin concentrate evaluation in children. Administration of antithrombin concentrate increases anti-factor Xa activity with lower administered unfractionated heparin doses.
    Pediatric Critical Care Medicine 06/2014; 15(8). DOI:10.1097/PCC.0000000000000174 · 2.33 Impact Factor
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