Recurrent stroke: the role of thrombophilia in a large international pediatric stroke population

Risk factors for arterial ischaemic stroke in children include vasculopathy and prothrombotic risk factors but their relative importance to recurrent stroke is uncertain. Data on recurrent stroke from the databases held in Canada (Toronto), Germany (Kiel-Lubeck/Munster), and UK (London/Southampton) were pooled. Data were available from 894 patients aged 1 month to 18 years at first stroke (median age 6 years) with a median follow-up of 35 months. 160/894 patients (17.9%) had recurrence from 1 day to 136 months after first stroke (median 3.1 months). Among 288 children with vasculopathy, recurrence was significantly more common (hazard ratio (HR) 2.5, 95% confidence intervals (CI) 1.92-3.5) compared to children without vasculopathy. Adjusting for vasculopathy, isolated antithrombin deficiency (HR 3.9; 95%CI 1.4-10.9), isolated elevated lipoprotein (a) (HR 2.3; 95%CI 1.3-4.1), and the presence of more than one prothrombotic risk (HR 1.9; 95%CI 1.12-3.2) were independently associated with an increased risk of recurrence. Recurrence rates calculated per 100 person-years were 10 (95%CI 3-24) for antithrombin deficiency, 6 (95%CI 4-9) for elevated lipoprotein (a), and 13 (95%CI 7-20) for the presence of more than one prothrombotic risk. Identifying children at increased for second stroke events is important in intensifying measures aimed at preventing recurrent stroke

Supplementary Material for: Psychometric Properties of a Modified KINDL-R Questionnaire for Adolescents and Adults, and Construction of a Brief Version, the KINDL-A(dult)B(rief) Questionnaire, KINDL-AB

<b><i>Background/Aims:</i></b> The generic quality of life KINDL-R ­questionnaire is validated for use in children/adolescents ≤16 years. The aim of this cross-sectional investigation was to modify the KINDL-R questionnaire for use in adults and to validate its psychometric properties. <b><i>Methods:</i></b> Five items of the KINDL-R questionnaire were adapted and the newly developed KINDL-A(dult) questionnaire administered to 255 patients with hereditary and acquired bleeding disorders (mean age 53 years). Its internal consistency and convergent and divergent construct validity were investigated and confirmatory factor analysis was used to evaluate the latent factor structure. <b><i>Results:</i></b> The KINDL-A questionnaire showed satisfactory reliability, varying construct validity, but inconclusive factor structure. The KINDL-AB(rief) was developed by removing half of the items and combining 2 sub-axes. This led to factor loadings between 0.62 and 0.91 and increased overall fit (Goodness of fit > 0.8 and Root Mean Square Error of Approximation, RMSEA, < 0.08). Results were validated in 966 healthy blood donors (mean age 38 years). In this group, the KINDL-AB questionnaire showed factor loadings between 0.43 and 0.77, Goodness of fit > 0.95 and RMSEA < 0.05. <b><i>Conclusions:</i></b> The new KINDL-AB suggests sufficient to good psychometric properties in adult patients with hereditary and acquired bleeding disorders