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

Lanthier, S., Kirkham, F. J., Mitchell, L. G., Laxer, R. M., Atenafu, E., Male, C., Prengler, M., Domi, T., Chan, A. K.C., Liesner, R. and DeVeber, G. (2004) Increased anticardiolipin antibody IgG titers do not predict recurrent stroke or TIA in children. Neurology, 62 (2), 194-200. (doi:10.1212/WNL.62.2.194).

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.

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Contributors

Author: F. J. Kirkham

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