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Abstract
Background: Increased anticardiolipin antibody (ACLA) immunoglobulin (Ig) G titers are commonly found in children with arterial ischemic stroke (AIS) or TIA (AIS/TIA). The associated risk of recurrent thromboembolism is unknown.
Objective: To determine the risk of recurrent thromboembolism associated with persistently increased ACLA titers of the IgG isotype in children with AIS/TIA.
Methods: The authors studied a cohort of children surviving first AIS/TIA tested by standardized ELISA for β2-glycoprotein I-dependent ACLA of the IgG isotype. Children with ACLA titers >15 IgG phospholipid (GPL) units (per manufacturer’s cutoff point) on more than two occasions ≥6 weeks apart were classified as ACLA-positive (ACLA+) and compared with ACLA-negative (ACLA−) children with respect to recurrent thromboembolic events (AIS/TIA, sinovenous thrombosis, and extracerebral thromboembolism).
Results: The authors recruited 34 ACLA+ children and 151 ACLA− children. Most ACLA+ children (30/34; 88%) had ACLA titers ≤40 GPL units. During the follow-up period (median duration, 2.8 years for ACLA+ children and 3.0 years for ACLA− children), AIS/TIA recurred in 26% of ACLA+ children and in 38% of ACLA− children; none developed sinovenous thrombosis or extracerebral thromboembolism. Based on survival analysis, this difference was nonsignificant (p = 0.54). Using binary partition evaluation, no titer criteria for ACLA positivity (range, 0 to 60 GPL units) predicted recurrent AIS/TIA.
Conclusion: In children surviving arterial ischemic stroke/TIA, increased anticardiolipin antibody immunoglobulin G titers do not predict recurrent thromboembolism.
- Received April 23, 2003.
- Accepted October 30, 2003.
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