Page 293

Karger_ESC London_2013

London, United Kingdom 2013 Acute stroke: new treatment concepts (PO 32 - 51) Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 293 31 Acute stroke: current treatment INTRACRANIAL HEMORRHAGES RELATED WITH WARFARIN USE and COMPARI-SON OF WARFARIN and ASA Y. Beckmann1, Y. Seçil2, F. Tokuçoğlu3, Y. Çiftçi4 Department of Neurology, Katip Çelebi University Atatürk Training and Research Hospital, Izmir, TURKEY1, Department of Neurology, Katip Çelebi University Atatürk Training and Research Hospital, Izmir, TURKEY2 Back ground: Anticoagulant and antiplatelet treatment with oral agents are widely used to prevent ischemic cerebrovascular and cardiac events and intracranial hemorrhage is the most important com-plication of warfarin use. Warfarin related intracerebral hemorrhage incidence is 0.2- 5% in popula-tion which accounts for 10-12 % of all intracerebral hemorrhages. In this article, we investigated the profile of antiaggregant drug acetyl salicylic acid and anticoagulant drug related spontaneous intra-cranial hemorrhages in comparison to intracranial hemorrhages without any drug use with their clini-cal, radiological and biochemical properties. Material and Methods: Four hundred eighty six patients aged 18 to 101 who had spontaneous intra-cranial hemorrhage were included in this study. There were four groups of patients namely warfarin, acetyl salicylic acid, acetyl salicylic acid plus warfarin and without any drug groups. Clinical, neuro-logical, etiological and radiolocical data of these patients were compared. Results: Four hundred eighty six spontaneous ICH patients 270 men and 21 women aged between 18 to 101 years (mean 62.22±16.46) were included in the study. There weare 32 patients in warfarin group and 58 patients ASA group. ASA+warfarin group included 7patients. Number of female pa-tients was more than males in warfarin group in comparison to other groups, which was statistically significant (p<0.05). According to years, although the total number of hemorrhage increase was re-markable, drug using groups’ numbers were nearly stable which means that patients in without any drug use group increased within this period. Most frequent type of hemorrhage was supratentorial in-traparenchymal hemorrhages which constituded all of the hemorrhages in acetyl salicylic acid +war-farin group. Isolated warfarin related intracranial hemorrhages is 6.6 % in our study, if we add ASA+ warfarin group it reaches 8 % of the total. Conclusion: It is very important result that warfarin and low Glasgow coma scale are bad prognostic factors and it is highly possible that patient could not find any chance to survive with these unfavor-able prognostic factors. 32 Acute stroke: new treatment concepts Thrombolytic treatment for unclear-onset stroke: a single centre experience R. Topakian1, T. Wolfsegger2, R. Pichler3 Department of Neurology, Academic Teaching Hospital Wagner-Jauregg, Linz, AUSTRIA1, Department of Neurology, Academic Teaching Hospital Wagner-Jauregg, Linz, AUSTRIA2, Institute of Nuclear Medicine, Academic Teaching Hospital Wagner-Jauregg, Linz, AUSTRIA3 Background: Data on the optimal management and early outcome in patients with unclear-onset stroke (UOS) are sparse. Our aim was to assess the impact of thrombolytic treatment (TT) on early neurological improvement (ENI) in patients with UOS. Methods: In our local prospective stroke registry we identified 330 consecutive patients admitted to our stroke unit who fulfilled the following criteria: 1) acute ischemic stroke confirmed by clini-cal and imaging definitions; 2) unclear onset of stroke; and 3) baseline National Institute of Health Stroke Scale (NIHSS) score of 4-22 points. ENI was defined as complete normalization or improve-ment of 4 or more points on the NIHSS during the patients´ stay in our stroke unit. Symptomatic intracerebral haemorrhage (SICH) was defined according to criteria of the Safe Implementation of Thrombolysis in Stroke – MOnitoring STudy (SITS-MOST). Results: 180 (54.5%) patients were men. 40 (12.1%) patients received IV and/or IA TT. ENI was observed in 85 (25.8%) patients. Compared to patients without early improvement (n=245), patients with early improvement (n=85) were younger mean age (SD) 67.3 (16.2) years vs. 71.2 (13.4) years, p=0.03 and had higher baseline NIHSS scores mean NIHSS (SD) 10.5 (5.4) vs. 8.9 (5.1), p=0.018. Patients who underwent TT significantly more often developed ENI than patients without TT (18/40, 45% vs. 67/290, 23.1%, p=0.003). SICH was more frequent in the TT group, but dif-ferences were non-significant (2/40, 5% in the TT group vs. 7/290, 2.4% in the group without TT, p=0.35). In a multivariable regression model adjusting for age, sex and baseline NIHSS score, TT was found to independently predict ENI (OR 0.44, 95%CI 0.22-0.90, p=0.025). Conclusion: Our data suggest that a subset of patients with UOS benefits from TT. Large prospective studies are needed to further elucidate safety and efficacy of TT for UOS.


Karger_ESC London_2013
To see the actual publication please follow the link above