What is the dosage of aspirin (acetylsalicylic acid) for a 12-year-old pediatric patient with acute ischemic stroke?

Aspirin Dosage for a 12-Year-Old with Acute Ischemic Stroke

For a 12-year-old pediatric patient with acute ischemic stroke, aspirin should be initiated at 1-5 mg/kg per day after cervical artery dissection and intracardiac thrombus have been excluded. 1

Initial Management Approach

Start with anticoagulation (heparin) or aspirin at established pediatric dosing immediately after brain imaging excludes intracranial hemorrhage. 1 This initial treatment should continue until two critical conditions are ruled out:

• Cervical artery dissection 1
• Intracardiac thrombus 1

Once both conditions are excluded, transition to acute aspirin therapy at the pediatric dose range.

Specific Dosing Recommendations

The recommended dose is 1-5 mg/kg per day. 1 For a typical 12-year-old weighing approximately 40 kg, this translates to 40-200 mg daily, though the exact dose should be calculated based on the patient's actual weight.

An initial dose of 3-5 mg/kg per day is reasonable for stroke prevention in children. 1 If dose-related side effects occur (gastric distress or prolonged epistaxis), the dose may be reduced to 1-3 mg/kg per day. 1

Critical Safety Considerations

Aspirin administration must be delayed until 24 hours after thrombolysis if tPA was given, and only after the post-thrombolysis scan excludes intracranial hemorrhage. 1 This is a non-negotiable safety requirement to prevent hemorrhagic complications.

Reye's syndrome risk requires specific precautions:

• Administer annual influenza vaccination 1
• Verify varicella vaccination status 1
• Withhold aspirin during confirmed or suspected influenza and varicella infections 1

There is no consensus on whether to discontinue aspirin during other febrile illnesses, though some experts recommend discontinuation or dose reduction during any febrile illness due to Reye's syndrome concerns. 1

Duration of Therapy

Treatment should continue for a minimum of 3-5 years, or longer if ongoing stroke risk factors persist (such as continued cerebral artery stenosis or major congenital heart disease). 1

Alternative Considerations

For children unable to tolerate aspirin, clopidogrel at 1 mg/kg per day may be used as an alternative. 1 However, the combination of aspirin and clopidogrel has been associated with subdural hemorrhage in children with diffuse vasculopathy and cerebral atrophy, so dual antiplatelet therapy should be avoided in pediatric patients. 1

Common Pitfalls to Avoid

• Do not use adult dosing regimens (160-325 mg) in pediatric patients, as these are not appropriate for children 1
• Do not start aspirin before excluding cervical artery dissection and intracardiac thrombus, as anticoagulation may be the preferred initial therapy if either condition is present 1
• Do not combine aspirin with clopidogrel in pediatric stroke patients due to increased bleeding risk 1
• Aspirin may worsen asthma symptoms, so monitor respiratory status carefully 1