London, United Kingdom 2013 23 Acute stroke: emergency management, stroke units and complications Informed consent using medical comics for a stroke patient`s family Y. Furuno1, H. Sasajima2, K. Aita3, T. Kawabe4, K. Owada5, K. Tatsuzawa6, K. Mineura7 Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural Uni-versity of Medicine, Kyoto, JAPAN1, Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JAPAN2, Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JAPAN3, Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JAPAN4, Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JAPAN5, Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JAPAN6, Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JAPAN7 Background: Although informed consent has become common in medical practice, there remains the gulf of understanding that exists between doctor and patient on the clinical conditions. Especial-ly, the emergent situation like strokes widens this gap because a patient’s family cannot understand technical terms under time constraint. Therefore we propose medical comics (so-called “Manga” in Japan) as a tool to bridge the gap so that we as a doctor can give informed consent intuitively, quick-ly and comprehensively. Methods: As a tool for informed consent, we created the medical comics about “subarachnoid hem-orrhage” and “intracerebral hemorrhage” to illustrate their pathogenesis, clinical condition, treat-ment and prognosis including rehabilitation. In order to evaluate our methodology, we carried out a questionnaire survey between September 2010 and September 2012 to investigate how these comics help the patient’s family in terms of time efficiency, the level of understanding, and the applicability of other medical cases. Results: The survey was answered by sixteen members of the patient`s families. 93.8% read these comics for less than 30 minutes. In terms of the level of understanding for brain function and anat-omy, for pathology of disease and for doctor`s explanation, 81.2%, 75.0% and 68.0% rated these comics as very useful or useful respectively. With regard to the applicability to other medical cases, 93.8% would strongly prefer or prefer that medical comics should be applied to other medical case. Conclusion: Medical comics facilitate informed consent during the emergency condition as they en-courage patient’s family to comprehend the facts, implications, and future consequences of an action in a short period of time. We think the visual and narrative illustration in the medical comic would be helpful for the patient’s family rather than a lengthy and verbal explanation conducted by a doc-tor. E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 567 22 Acute stroke: emergency management, stroke units and complications Safety of intravenous thrombolysis for acute ischemic stroke in patients treated with warfarin. M.V. Mazya1, K.R. Lees2, R. Markus3, R. Roine4, RCS Seet5, N. Wahlgren6, N. Ahmed7 SITS Investigators Department of Neurology, Karolinska University Hospital, Stockholm, SWEDEN1, Acute Stroke Unit & Cerebrovascular Clinic, Institute of Cardiovascular & Medical Sciences, Universi-ty of Glasgow, Glasgow, UNITED KINGDOM2, Department of Neurology, St. Vincent’s Hospital, Sydney, AUSTRALIA3, Department of Neurology, Turku University Hospital, Turku, FINLAND4, Division of Neurology, National University Hospital, Singapore, SINGAPORE5, Department of Neurology, Karolinska University Hospital, Stockholm, SWEDEN6, Department of Neurology, Kar-olinska University Hospital, Stockholm, SWEDEN7 Background: Controversy surrounds the safety of intravenous tissue plasminogen activator (iv tPA) in ischemic stroke patients treated with warfarin. The European tPA license precludes its use in an-ticoagulated patients altogether. American guidelines accept iv tPA use with an international nor-malized ratio (INR) >/=1.7. The influence of warfarin on symptomatic intracerebral hemorrhage (SICH), arterial recanalization and long-term functional outcome in stroke thrombolysis remains unclear. Methods: We analysed data from 45074 patients treated with iv tPA enrolled in the SITS Internation-al Stroke Thrombolysis Register. 1110 patients had baseline warfarin treatment. Outcome measures were SICH, arterial recanalization, mortality and functional independence at three months. Results: Patients on warfarin with INR</=1.7 were older, had more co-morbidities, and more severe strokes. Adjusted for age, stroke severity and co-morbidities, there were no significant differences in rates of SICH per SITS-MOST (adjusted OR (aOR) 1.23 (95% CI 0.72-2.11; p=0.46), ECASS II (aOR 1.31 (0.96-1.79); p=0.09) and NINDS (aOR 1.24 (0.95-1.62); p=0.12) definitions. Neither did warfarin independently influence mortality, aOR 1.05 (0.83-1.35); p=0.66, nor functional inde-pendence at three months, aOR 1.01 (0.81-1.24); p=0.96. Arterial recanalization trended higher in warfarin patients, 37/59 (62%) versus 776/1475 (55%), p=0.066 at 22-36 hours. Recanalization ap-proximated by disappearance at 22-36 hours of an initial hyperdense middle cerebral artery sign was similarly increased, 124/196 (63%) vs 3901/7099 (55%), p=0.022. Conclusions: Warfarin treatment with INR≤1.7 does not increase the risk for SICH or death, and has no impact on long-term functional outcome in patients treated with intravenous tPA for acute ischemic stroke.
Karger_ESC London_2013
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