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London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 339 111 Stroke prognosis Clopidogrel resistance in cerebrovascular patients G. Feher1, L. Szapary2 William Harvey Hospital, Ashford, UNITED KINGDOM1, Department of Neurology, Univeristy of Pecs, Pecs, HUNGARY2 INTRODUCTION – Even though patients who develop ischemic stroke despite taking clopidogrel represent a considerable proportion of stroke hospital admissions, there is a paucity of data from in-vestigational studies regarding the most suitable therapeutic intervention. PATIENTS AND METHODS – 100 patients with a history of acute stroke or transient ischaemic at-tack were involved in our study. The efficiency of the therapy was assessed on day 7, 28, month 3,6 and 12 of medical therapy. Patients were divided into two parts (clopidogrel responder and resistant) based on their initial laboratory findings. Risk profiles, medical therapy, laboratory parameters and vascular events were compared between the two patient groups. RESULTS – At the first measurement (day 7) after clopidrogel treatment, the therapy seemed to be inefficient in 11 patients (11%). A strong, clinically significant correlation was found between blood pressure values, blood glucose and lipid parameters, hsCRP levels and platelet aggregation values. At the next measurements, an aggressive secondary preventive threapy resulted in the normalisation of the above mentioned parameters, and the efficiency of platelet aggregation inhibtion therapy was also improed, whereas no patients proved to be resistant. Initial clopidogrel resistant patients had a significiantly higer rate of vascular events (18,1 vs. 4,5 %, , p < 0,01) compared to responder ones, although resistance seemed not to be an independent risk factor of unfavourable vascular outcome in a multivariate analysis. No unwanted events or haemorrhagic complications were registered. CONCLUSIONS – On the basis of the result of our study, the significance of an aggressive second-ary preventive therapy should be considered as a factor that might influence the efficiency of throm-bocyte aggregation inhibitory therapy. 112 Stroke prognosis The high sensitivity C-reactive protein cut-off value for prediction of early mortality after ischemic stroke M. Ghabaee1, A. Zndieh2, S. Mohebbi3, H. Sadeghian4, M. Ghaffarpour5, R. Motiei-Langroudi6, M.R. Mousavi-Mirkala7 Iranian Center of Neurological Research,Neurology Depatement, Tehran University of Medi-cal Sciences, Tehran, IRAN1, Iranian Center of Neurological Research, Tehran University of Med-ical Sciences, Tehra, IRAN2, Iranian Center of Neurological Research,Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, IRAN3, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, IRAN4, Iranian Center of Neurological Research, Neurology Departement, Tehran University of Medical Sciences, Tehran, IRAN5, Depart-ment of Neurosurgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IRAN6, Tehran University of Medical Scien, Tehran, IRAN75 We aimed to compare the association of high-sensitivity C-reactive protein (CRP) and national in-stitutes of health stroke scale (NIHSS) score with mortality and to determine the optimal threshold of CRP for prediction of mortality in ischemic stroke patients. A series of 162 consecutive patients with first ever ischemic stroke admitted within 24 hours after onset of symptoms to a university affiliated hospital were enrolled. CRP and NIHSS score were estimated on admission and their pre-dictive abilities for mortality at seven days were determined by logistic regression analyses. Re-ceiver- Operating Characteristic (ROC) curves were depicted to identify the optimal cut-off of CRP, using the maximum Youden index and the shortest distance methods. Deceased patients had higher levels of CRP and NIHSS on admission (8.87±7.11 vs. 2.20±4.71 mg/l for CRP, and 17.31±6.36 vs. 8.70±4.85 U for the value of NIHSS in patients who died and those survived, respectively, P<0.01). CRP and NIHSS were correlated with each other (r2= 0.39, P<0.001) and were also independently associated with increased risk of mortality Odds ratios (95% confidence interval) of 1.16 (1.05- 1.28) and 1.20 (1.07-1.35) for CRP and NIHSS, respectively, P<0.01. The areas under the ROC curves of CRP and NIHSS for mortality were 0.82 and 0.84, respectively. The CRP value of 2.2 mg/l was identified as the optimal cut-off value for prediction of mortality (sensitivity: 0.81, specificity: 0.80). Thus, CRP is regarded as an independent predictor of mortality following ischemic stroke and the value of 2.2 mg/l yields the optimum sensitivity and specificity for mortality.


Karger_ESC London_2013
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