OBJECTIVE To explore personalized antiplatelet regimens and key pharmaceutical care considerations for pediatric acute ischemic stroke, providing evidence for clinical medication safety.

METHODS Comprehensive pharmaceutical care was implemented for a 12-year-old child with severe stenosis-occlusion of the proximal left internal carotid artery. The pharmacist systematically retrieves literature and assists physicians in designing antiplatelet drug therapy regimens based on individual pediatric cases, while monitoring for adverse reactions such as bleeding.

RESULTS The child was diagnosed with severe stenosis to occlusion of the proximal left internal carotid artery. This type of stroke was relatively rare in children. Since the child was already 12 years old and has reached an adult weight, a dual antiplatelet therapy regimen was selected with reference to adult treatment guidelines. Additionally, the pediatric patient presented with obesity(body mass index=29.2), which might reduce responsiveness to antiplatelet therapy. During hospitalization, the patient received ibuprofen multiple times for post-lumbar puncture back pain. This use of ibuprofen could potentially reduce the antiplatelet efficacy of aspirin while increasing the bleeding risk. The physician adopted the pharmacist’s recommended dual antiplatelet therapy regimen of aspirin enteric-coated tablets 100 mg orally once daily and clopidogrel tablets 75 mg orally once daily. Concurrently, ibuprofen was discontinued for analgesia and replaced with dexamethasone injection 5 mg administered via intravenous drip. By day 4 of treatment, the patient’s right-hand grip strength had improved compared to baseline, and limb mobility was unrestricted. On day 7, the patient experienced grade Ⅰ epistaxis(nasal bleeding), which was controlled with manual compression. Overall, the treatment demonstrated favorable effectiveness and safety.

CONCLUSION Pediatric acute ischemic stroke requires personalized antiplatelet regimens. Currently, there is limited evidence-based evidence for the use of dual antiplatelet therapy with aspirin and clopidogrel in the treatment of acute ischemic stroke in children, the case provides new evidence regarding the benefit-risk balance of dual antiplatelet therapy, underscoring the need for further high-level multicenter clinical trials in children to validate the effectiveness and safety of this regimen.