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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 711 690 Acute stroke: clinical patterns and practice Thrombolytic therapy in a patient with essential thrombocytosis C. Krogias1, B. Zurawski2, P. Mönnings3, R. Gold4, S.H. Meves5 Dept. of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany, Bochum, GER-MANY1, Dept. of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany, Bochum, GERMANY2, Dept. of Radiology, St. Josef-Hospital, Ruhr University Bochum, Germany, Bochum, GERMANY3, Dept. of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany, Bochum, GERMANY4, Dept. of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany, Bochum, GERMANY5 Background: Essential thrombocythemia (ET) is a myeloproliferative disorder and it represents a rare cause of cerebrovascular disorders. On the one hand there is an elevated risk of recurrent ischemic stroke whereby many factors contribute to the hypercoagulabity state as JAK2 mutation. On the other hand, due to the platelet dysfunction there coexists an elevated risk for cerebral bleedings. To date, no date about safety and feasibility of thrombolitic therapy in ET patients with acute ischemic stroke are available. Methods: Case report of a 62-year-old patient with essential thrombocythemia presenting with acute onset of right-sided hemiparesis and aphasia (NIHSS-Score=14 points). It was a recurrent cerebroischemic event and the patient was under antiplatelet medication with acetylsalicylic acid. Initial cranial CT and CT angiography revealed early signs for posterior cerebral artery infarction on the left in combi-nation with a distal P1-/proximal P2 artery occlusion on the left. Full dose (0.9mg/kg rt-PA) system-ic thrombolysis was performed 125 min post onset. Results: In the short-term follow-up only a slight clinical improvement could be achieved (NIHSS-Score at discharge on day 9 = 11 points; mRS= 3 at day 30). Follow-up cCT demonstrated infarction without any signs of haemorrhagic transformation. Further laboratory test detected JAK2 V617F-Mutation. Conclusion: To the best of our knowledge, this is the first report about thrombolytic therapy in a stroke patient with essential thrombocytosis. It is unclear if this myeloproliferative disorder with platelet dysfunc-tion and elevated bleeding risk represents a contraindication for thrombolysis. In our case no com-plication occurred, not even signs of hemorrhagic transformation of the infarct. Of course, further and larger case series are needed to confirm feasibility and safety of thrombolytic therapy in patients with ET. 691 Acute stroke: clinical patterns and practice Factors Predicting Intracerebral Hemorrhage and In-hospital Mortality after Thrombolytic Therapy for Taiwanese Acute Ischemic Stroke Patients: an 8-year Nationwide Survey C.Y. Hsieh1, C.H. Chen2, Y.H. Kao Yang3, Tainan Sin Lau Hospital, Tainan, TAIWAN1, Stroke Center and Department of Neurology, Na-tional Cheng Kung University, Taiana, TAIWAN2, Institute of Clinical Pharmacy and Pharmaceuti-cal Science, Tainan, TAIWAN3 Background: Recombinant tissue plasminogen activator (rtPA) is the only effective treatment for acute ischemic stroke (AIS). However, debate has been raised when the regulators in Taiwan used accreditation of every medical center or regional hospital to force the implementation of rtPA across the nation. We aim to analyze factors predicting intracerebral hemorrhage (ICH) and in-hospital mortality after thrombolytic therapy for Taiwanese AIS patients using a national dataset. The hy-pothesis we want to test is that the experience of thrombolytic therapy of each hospital has an in-verse relationship with complications after rtPA for AIS patients admitted. Methods: We identified all hospitalized AIS patients receiving rtPA in the whole-population National Health Insurance Research Database, 2003-2010. The outcome of interest included ICH and in-hos-pital mortality after rtPA for AIS. In addition to total rtPA experience of each hospital, the following factors were adjusted in the multiple regression models including age, sex, co-morbidities of the pa-tients (i.e. Charlson co-morbidity index), weekend admission or not, and physician’s specialty. Results: We identified a total of 2,742 AIS patients with thrombolytic therapy, accounting for 0.68% of all AIS hospitalized patients during 2003-2010. The rates of ICH and in-hospital mortality are 3.96% and 9.18%, respectively. After adjusting for age, sex, co-morbidities, weekend admission, and physician’s specialty, we found ICH was significantly associated with an increase of in-hospital mortality (adjusted odds ratio OR: 5.288; 95% confidence interval CI: 3.167-8.831), while rtPA experience of each hospital was associated with a decrease of ICH (adjusted OR: 0.992, 95% CI: 0.986-0.998) for patients receiving rtPA. Conclusion: The maxim “practice makes perfect” may be also applicable in stroke thrombolysis. Our results provide evidence regarding the urgent need to integrate the emergency medical service and centralize hospitals providing thrombolytic therapy for AIS patients in Taiwan.


Karger_ESC London_2013
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