Is Clot-Busting Drug Safe for Kids with Strokes?

New research looks at whether clot-busting drugs can safely be given to children who have strokes. The research was released today and will be presented at the American Academy of Neurology’s 64th Annual Meeting in New Orleans April 21 to April 28, 2012.

In adults, the clot-busting drugs can reduce disability if given within a few hours after stroke symptoms begin. But few studies have looked at whether the drugs are safe for children.

The study used a national database to look at all children admitted to a hospital with a diagnosis of ischemic stroke from 1998 to 2009. Only ischemic strokes can be treated with clot-busting drugs; they are the most common type of stroke.

Of the 9,367 children who were admitted with ischemic stroke, only 75 children, or 0.8 percent, received clot-busting drugs, also called thrombolytic therapy. Intracerebral hemorrhage, or bleeding in the brain, is a risk of thrombolytic therapy. The four percent rate of hemorrhage in the 75 kids who received thrombolytic therapy was higher than the 0.38 percent rate in kids who did not receive the therapy, but it was similar to the rate in adults who receive thrombolytic therapy.

Children who received thrombolytic therapy were no more likely to die following the stroke than those who did not receive the therapy.

About clot-busting drugs

Also known as thrombolytics, clot busters are medications given intravenously (I.V.) to a patient to break up a blood clot. If the patient is having a heart attack or an ischemic stroke, clot busters may reduce the damage to the heart or brain and prevent death.

Although blood clotting is a vital and natural bodily function, a blood clot can be deadly if it is large enough to block a blood vessel (thrombus), or if either part of the blood clot or the entire clot breaks off and travels through the bloodstream to lodge in a blood vessel elsewhere (embolism). Unlike anticoagulants, which can prevent blood clots from forming or becoming larger, clot busters are the only types of medication currently available that can actually destroy a blood clot.

Clot busters must be administered quickly and properly through several specifically timed I.V. infusions according to a rigid protocol established for each drug and the body weight of each patient. Research has shown that these medications are most effective when given within two hours of the onset of symptoms for heart attack or three hours for stroke. Therefore, better recognition of the signs and symptoms of these conditions could increase the number of patients who benefit from the use of clot-busting drugs.

The drugs are more likely than anticoagulants to cause bleeding problems, and errors in dosage or timing of delivery can be fatal. Because they are complicated drugs to administer, they are generally used only when the patient is in a hospital (although they could be used by emergency personnel outside the hospital). Emergency room teams must start the treatment as soon as possible, usually within a half-hour of the patient’s arrival. Treatments can remain effective for up to four hours after a heart attack or stroke.