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Increased anticardiolipin antibody IgG titers do not predict recurrent stroke or TIA in children

From the Cerebrovascular Disease Centre, Division of Neurology, Department of Medicine (Dr. Lanthier), Centre hospitalier de l’Université de Montréal and Montreal Heart Institute, Canada; Neurosciences Unit (Drs. Prengler and Kirkham), Institute of Child Health, University College, London, UK; Department of Hematology (Dr. Liesner), Great Ormond Street Hospital for Children, London, UK; Divisions of Population Health Sciences (Dr. deVeber, L.G. Mitchell and E. Atenafu), Rheumatology (Dr. Laxer), and Neurology (Dr. deVeber, T. Domi), Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Clinical Epidemiology and Biostatistics (L.G. Mitchell) and Division of Hematology, Department of Pediatrics (Dr. Chan), McMaster University, Hamilton, Canada; and Division of Hematology, Department of Pediatrics (Dr. Male), Children’s Hospital, University of Vienna, Austria.

Address correspondence and reprint requests to Dr. S. Lanthier, Centre des maladies vasculaires cérébrales, Centre hospitalier de l’Université de Montréal–Hôpital Notre-Dame, 1560 Sherbrooke St. East, Suite G-4123, Montreal, Quebec, Canada, H2L 4M1; e-mail: sylvain.lanthier.chum{at}ssss.gouv.qc.ca

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 ß₂-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 in final form October 30, 2003.

Presented at the 53rd Annual Meeting of the American Academy of Neurology, Philadelphia, PA, May 7, 2001, and the 10th European Stroke Conference, Lisbon, Portugal, May 18, 2001.

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