Arterial ischemic strokes occur in approximately 1.6 per 100,000 children per year. Although rare, such strokes are devastating for children, parents and family members. Recurrent strokes are even more difficult to handle.

A recent study suggests that recurrence may depend on the type of stroke the children suffer. It did not assess other factors, but the results might be useful for healthcare professionals seeking to prevent children from having another stroke.

The researchers examined 107 children who were admitted to The Children’s Hospital of Philadelphia with childhood arterial ischemic strokes (CAIS) between Jan. 1, 2006 and Jan. 1, 2015. The children’s strokes occurred when they were between 29 days and 17.99 years old.

The median age at the time of arterial ischemic strokes was 7.7 years old, while 57 percent of the children had a CAIS isolated to the posterior circulation (PCAIS) and 43 percent who had a CAIS isolated to the anterior circulation (ACAIS).

Three years after the stroke, 10.3 percent of children had another stroke, including 19 percent in the PCAIS group and 4 percent in the ACAIS group. A univariable analysis found the hazard ratio for recurrence after PCAIS compared with after ACAIS was 6.4. Meanwhile, a multivariable analysis that included sex and cervical dissection found the hazard ratio for recurrence after PCAIS compared with after ACAIS was 5.3. Both differences were statistically significant.

“Children with PCAIS may warrant increased monitoring,” the researchers wrote in JAMA Neurology on Jan. 23. “This study highlights the necessity for further research focused on prevention of recurrence, including the safety and efficacy of dual antithrombotic therapies.”

The risk of recurrent strokes occurred soon after the initial stroke. Of the 11 children with a recurrent stroke, 10 occurred within the first six months and 5 occurred within the first month. Most patients who had recurrent AIS had a single recurrence and benefited from treatment modification, according to the researchers.

All of the patients with recurrent strokes and 92.5 percent of the overall group received antithrombotic medication. All but one patient received monotherapy. The researchers noted that four patients with recurrent strokes were receiving anticoagulation therapy and the remaining seven patients were taking aspirin at the time of recurrence. They mentioned, though, that the study’s observational design did not allow them to compare aspirin and anticoagulation therapy.

“Our results raise a question as to whether current protocols that use antithrombotic monotherapy are sufficient to prevent recurrent strokes in children with PCAIS,” the researchers wrote. “Furthermore, results of this study suggest that children with PCAIS may benefit from a different approach to secondary stroke prevention. One such area that deserves further investigation is treatment with both an anticoagulant and antiplatelet agent. However, systematic evaluation of safety and efficacy of this dual approach warrants specific study before it is widely adopted because hemorrhagic transformation is common following CAIS, and dual therapy could increase the risk for hemorrhagic transformation.”