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London, United Kingdom 2013 3 Meta-analysis and reviews 16:50 - 17:00 Cerebral microbleeds and recurrent stroke risk: systematic review and meta-analysis of prospective ischemic stroke and TIA cohorts A. Charidimou1, P. Kakar2, Z. Fox3, D.J. Werring4 Stroke Research Group, UCL Institute of Neurology and The National Hospital for Neu-rology and Neurosurgery, Queen Square, London, UNITED KINGDOM1,Department of Stroke Medicine, Imperial College Healthcare, NHS Trust, London, UNITED KINGDOM2, Education Unit, UCL Institute of Neurology, Queen Square, London, UNITED KINGDOM3, Stroke Research Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UNITED KINGDOM4 Background: Cerebral microbleeds (CMBs) are increasingly detected in ageing, cerebrovascu-lar disease and cognitive impairment. Whether CMBs predict increased future stroke risk (par-ticularly intracerebral haemorrhage ICH) in patients with ischaemic stroke or transient isch-emic attack (TIA) remains a key clinical question; results to date have been inconsistent. Methods: We performed a systematic review and meta-analysis of prospective cohorts with recent ischemic stroke/TIA. We critically appraised studies, and calculated pooled odds ratios (ORs) using the Mantel-Haenszel fixed effects method of ICH or recurrent ischemic stroke, in patients with vs. without CMBs. We further stratified our analysis by study population ethnicity (Asian vs. Western Caucasian). Results: We pooled data from ten cohorts (n=3067). CMBs were associated with a significantly increased risk of any recurrent stroke (OR: 2.25; 95%CI: 1.70-2.98; p<0.0001), ICH (OR: 8.52; 95%CI: 4.23-17.18; p=0.007) and ischemic stroke (OR: 1.55; 95%CI: 1.12-2.13; p<0.0001). When stratified by study population ethnicity, the association of CMBs with ICH was signifi-cant for Asian cohorts (n=1915; OR: 10.43; 95%CI: 4.59-23.72; p<0.0001), but borderline and of lower magnitude for Western cohorts (n=885; OR: 3.87; 95%CI: 0.91-16.4; p=0.066). By contrast, there was a significant association of CMBs with recurrent ischemic stroke in Western (three studies; n=899; OR: 2.23; 95%CI: 1.29-3.85; p=0.004), but not Asian cohorts (four stud-ies; n=1357; OR: 1.30; 95%CI: 0.88-1.93; p=0.192). Conclusion: There is consistent evidence of an increased risk of recurrent stroke after ischemic stroke or TIA in patients with CMBs. The risk for spontaneous ICH appears to be greater than the risk for recurrent ischemic stroke. Our findings also suggest that the balance of risk for ICH vs. ischemic stroke differs between Asian and Western cohorts. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 157 2 Meta-analysis and reviews 16:40 . 16:50 Therapeutic hypothermia and the risk of infection: a systematic review and meta-analysis M. Geurts1, M.R. Macleod2, R. Kollmar3, H.B. van der Worp4 University Medical Centre Utrecht, Utrecht, THE NETHERLANDS1,Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UNITED KINGDOM2, Klinik für Neu-rologie und Neurogeriatrie, Klinikum Darmstadt, Darmstadt, GERMANY3, University Medical Centre Utrecht, Utrecht, THE NETHERLANDS4 Background: Hypothermia is a promising treatment for patients with acute ischemic stroke and is currently tested in phase II and III randomised trials. Observational studies suggest that infec-tions are a common complication of therapeutic hypothermia, but this was not supported by the results of individual randomised trials. We performed a systematic review and meta-analysis of randomised trials to examine the risk of infections in patients treated with hypothermia. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were sys-tematically searched for eligible studies up to October 1st, 2012. We included randomised con-trolled clinical trials of therapeutic hypothermia induced in adults for any indication, which reported the occurrence of infection in each treatment group. For each study we collected infor-mation about the baseline characteristics of patients, cooling strategy, and infections. Results: 23 studies were identified, including 2820 patients, of whom 1398 (49.6%) were ran-domised to hypothermia. Data from 31 randomised trials, involving 4004 patients, could not be included because the occurrence of infection was not reported with sufficient detail, or not at all. In patients treated with hypothermia, the incidence of all infections was not increased (rate ratio (RR), 1.22; 95% confidence interval (CI), 0.95 – 1.57), but there was an increased inci-dence of pneumonia and of sepsis (RR, 1.44; 95% CI, 1.11-1.86 and RR, 1.79; 95% CI, 1.00 – 3.17, respectively). Studies in patients with stroke were too small to provide reliable informa-tion on the occurrence of infections. Conclusion: There is no conclusive evidence that therapeutic hypothermia increases the overall risk of infection, but hypothermia does increase the risk of pneumonia and sepsis. Randomised trials of hypothermia should report on this important complication. Future research should fo-cus on identifying high-risk patients, and the effect of prophylactic antibiotic treatment.


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