22. European Stroke Conference 29 Acute stroke: current treatment Acute ischemic stroke: What to do when aspirin fails? A. Lago1, V. Parkhutik2, J.I. Tembl3, C. Aguilella4, M.J. Ibáñez5, D. Gorriz6, M. Frasquet7 HU La Fe, Valencia, SPAIN1, HU La Fe, Valencia, SPAIN2, HU La Fe, Valencia, SPAIN3, HU La Fe, Valencia, SPAIN4, HU La Fe, Valencia, SPAIN5, HU La Fe, Valencia, SPAIN6, HU La Fe, Valen-cia, 292 © 2013 S. Karger AG, Basel Scientific Programme SWAZILAND7 Background and Purpose: The best antiaggregation strategy for patients that present with ischemic stroke while taking aspirin is not known. Platelet function during the acute phase of ischemic stroke is assessed: patients that continue their treatment with aspirin, are started on clopidogrel or add clopidogrel to aspirin. Methods: Two hundred sixty nine consecutive patients with ischemic stroke/TIA in which platelet function was measured in the acute phase were included. Sixty for patients (24%) were previously on aspirin. Platelet function was studied within the first 72 hours. Three groups, were definded: A): aspirin 100-300 mg/day or acetylsalicylate of lysine 450 mg/day, n=30; B) clopidogrel 75 mg/day, n=15; and C): aspirin 100-300 mg plus clopidogrel 75mg/day, n=10. Collagen-induced TXA2 syn-thesis, ADP-induced aggregation and collagen-epinephrine PFA-100 closure times were measured. Results: Patients treated with clopidogrel only had a marked elevation of TXA2 and a shortening of the PFA-100 closure time compared to the other two groups. They achieved a small reduction of ADP-induced aggregation (17%) compared to the aspirin-only group. No differences were found be-tween the aspirin and aspirin+clopidogrel groups. Conclusions: Patients that exchange aspirin for clopidogrel are not fully protected during the first days after an ischemic stroke. This window of decreased antithrombotic protection can be mini-mized by maintaining aspirin for a few days. 30 Acute stroke: current treatment Long - term outcome of cerebral thrombolysis in extended” time window” in routine practice – an observational study. P. Sobolewski1, G. Kozera2, R. Kazmierski3, S. Michalak4, W. Szczuchniak5, M. Sledzinska-Dzwi-gal6, W. Nyka7 Department of Neurology and Stroke Unit of Hospital in Sandomierz, Sandomierz, POLAND1, Department of Neurology, Medical University of Gdańsk, Gdańsk, POLAND2, Department of Neurology and Cerebrovascular Disorders, Poznań ; University of Medical Sciences, Poznań, PO-LAND3, 4Department of Neurochemistry and Neuropathology, Poznań University of Medical Sci-ences, Poznań, POLAND4, Department of Neurology and Stroke Unit of Hospital in Sandomierz, Sandomierz, POLAND5, Department of Neurology and Stroke Unit of Hospital in Sandomierz, San-domierz, POLAND6, Department of Neurology, Medical University of Gdansk, Gdańsk, POLAND7 Background and purpose: The use of systemic cerebral thromobolysis (iv-thrombolysis) up to 4.5 hours from the stroke onset was approved in Poland in July 2010, but it’s safety and efficacy in Polish stroke units has not been fully determined to date. Thus, the aim of the study was to assess the long-term outcome and complication rates of iv-thrombolysis performed in the extended “time window”. Material and methods: the study included 291 ischemic stroke patients consecutively treated with iv-thrombolysis from 2006 to 2011 in 3 comprehensive stroke centers in Poland. The severity of stroke deficit assessed by NIHSS on admission, the long-term outcome assessed by mod-ified Rankin scale (mRS) 3 months after the stroke onset, the hemorrhagic complications rate, the presence of the risk factors and demographic profiles were compared between subgroups of patients treated within 3 and within 3-4.5 hours from the stroke onset. Results: 216 (74,2%) of patients were treated up to 3 hours and 75(25.8%) between 3 and 4.5 hrs. from the stroke onset. There were no dif-ferences concerning the gender, age and the presence of risk factors between both groups. Neurolog-ical deficit was more severe in patients treated <3 than in those treated 3-4.5 hours (NIHSS 12 vs. 10 pts. p=0.047) but the ratio of patients with a favorable outcome (mRS 0-2 pts.) and mortality didn’t differ between both groups (55.1 vs. 66.7; p=0,08 and 15.7 vs. 14.7; 0,055 respectively). The rate of hemorrhagic complications was lower in patients treated between 3 and 4.5 than in those treated < 3 hours from the stroke onset (19.4% vs. 9.3%, p=0.034). Conclusion: Iv-thrombolysis performed in extended “time window ” shows non-inferiority to procedures performed within 3 hours from the symptoms onset in routine clinical practice.
Karger_ESC London_2013
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