London, United Kingdom 2013 22 Stroke prevention Measurement of platelet reactivity in ischemic stroke patients undergoing antiplatelet therapy: an observational study A. Zini1, F. Rosafio2, A. Verzelloni3, N. Lelli4, T. Trenti5, G. Bigliardi6, M.L. Dell’Acqua7, R. Pen-tore8, E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 577 P.F. Nichelli9 Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY1, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY2, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY3, Laboratory of Toxicology - Nuovo Ospedale Civile S.Agostino Estense - Modena, Modena, ITALY4, Laboratory of Toxicology - Nuovo Osped-ale Civile S.Agostino Estense - Modena, Modena, ITALY5, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY6, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY7, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY8, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY9 Background. Few studies have investigated individual responsiveness to antiplatelet medications in stroke patients. Objective. The aim of the present study was to assess ASA and Clopidogrel (Clop) responsiveness using impedance aggregometry on a Multiplate analyzer in stroke patients within 24 hours from acute event in antiplatelet home therapy (first study population) and before discharge (second study population). In some patients in Clop treatment, we also studied genetic polymorphisms. Methods. The first group included 150 patients: 117 in ASA and 33 in Clop therapy. The second study population included 250 patients: 117 in ASA and 133 in Clop therapy. The platelet function was evaluated respectively within 24 hours from acute event and 1 week after the introduction of an-tiplatelet therapy. Results. In the first group, 88% of patients in therapy with ASA and 88% patients in Clop therapy were responders. In the second group 92% patients in therapy with ASA and 62% in Clop therapy were responders. CYP2C19 most common genetic variants were studied in 84 pa-tients in Clop therapy. In 43 normal metabolizers (allelic variants *1/*1 and *2/*17), 28 were Clop responders and 15 were non-responders. In 15 slow metabolizers (*2/*2 and *1/*2), 9 patients were Clop responders and 6 were non-responders. In 26 fast metabolizers (*17/*17 and *1/*17), 20 pa-tients were Clop responders and 6 were non-responders. Conclusion. Multiplate analyzer enables quick measurement of platelet reactivity in patients under-going antiplatelet therapy. Follow-up of these patients will be important to establish if there is a cor-relation between recurrence of ischemical event and therapeutic non-response, to verify the respon-siveness of discharge antiplatelet theraphy, if there is a higher risk of bleeding among ultraresponder patients, if the Clop response might be time-depending and finally the role of genetic polymor-phisms. 21 Acute cerebrovascular events (ACE): TIA and minor strokes Stroke risk after a first late-onset migraine-like transient neurological attack (TNA): Oxford Vascular Study TNA Cohort M.A. Tuna1, Z. Mehta2, P.M. Rothwell3 on behalf of the Oxford Vascular Study Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UNITED KINGDOM1, Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UNITED KINGDOM2, Stroke Prevention Re-search Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UNITED KINGDOM3 BACKGROUND: New migraine-like TNAs in older adults can be due to migraine aura or TIA. Clinical distinction can be difficult after a first attack, particularly in older patients with vascular risk factors. In the absence of previous prospective population-based studies, we determined the long-term risk of stroke in patients with new migraine-like TNAs, defined pragmatically as those in whom the assessing neurologist was unable to say confidently that the event was a definite aura or a definite TIA. METHODS: As part of a population-based study of all TNAs, TIAs and strokes (Oxford Vascular Study; 2002-2012), we ascertained all patients with a first migraine-like TNA in whom the study neurologist was not confident that the event was either a definite migraine aura or a definite TIA. Risk of stroke was determined by long-term regular face-to-face follow-up and was compared with the rate expected on the basis of age-sex specific stroke incidence in the underlying study population and with the rate observed in study patients with definite TIA. RESULTS: 158 consecutive patients with eligible migraine-like TNAs (97 women and 61 men; me-dian age= 61.3 years) had 776 patient-years of follow-up. The 90-day risk of stroke (n=2, 1.26%) was lower than that expected after a definite TIA (age and sex-adjusted HR=0.23, 0.07-0.89). The subsequent risk of stroke (n=8; 1.1/100 patient-years) was non-significantly greater than expected based on background population incidence (n=2.73; 0.37/100 patient-years), but remained lower than that after definite TIA (HR=0.58, 0.36-0.84). Nine of the 10 strokes on follow-up were isch-aemic and 3 were in the posterior circulation. CONCLUSIONS: The short and long-term risks of stroke in patients with a first migraine-like TNA are significantly lower than after a definite TIA. The trend towards a higher stroke risk than the un-derlying population rate is similar to that seen in studies of individuals with clinically-definite mi-graine with aura.
Karger_ESC London_2013
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