London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 677 623 Acute stroke: emergency management, stroke units and complications A TREND ANALYSIS OF FIBRINOGEN LEVELS AFTER THROMBOLYSIS: A RISK FACTOR FOR INTRACEREBRAL HEAMORRHAGES AFTER t-PA? A. Zini1, L. Vandelli2, M.E. Gambini3, M. Marietta4, T. Trenti5, A.M. Cenci6, F. Casoni7, R. Pen-tore8, M.L. Dell’Acqua9, G. Bigliardi10, P.F. Nichelli11 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, Environmental Protection Agency ARPA Emilia Romagna Dis-trict of Reggio Emilia, Reggio Emilia, ITALY3, Department of Oncology and Haematology, Section of Haematology, Policlinico of Modena,, Modena, ITALY4, Clinical Pathology-Toxicology, Nuovo Ospedale Civile S.Agostino-Estense, AUSL Modena, Modena, ITALY5, Clinical Pathology-Toxi-cology, Nuovo Ospedale Civile S.Agostino-Estense, AUSL Modena, Modena, ITALY6, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITA-LY7, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Mode-na, Modena, ITALY8, Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY9,Stroke Unit - Neurology Clinic - Dept. Neuroscience - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY10, Stroke Unit - Neurology Clinic - Dept. Neuro-science - Nuovo Ospedale Civile - AUSL Modena, Modena, ITALY11 Background: Whithin the predictive factors implicated in intracerebral hemorrhages (IH) in stroke patients treat-ed with tissue-Plasminogen Activator (t-PA) there is an early t-PA related coagulopathy that caused a decrease of fibrinogen levels. In our previous studies of 2010 we noted that there was a rate of IH significatively increased in patients with secondary hypofibrinogenemia. Methods: We considered 55 consecutive ischemic stroke patients treated with i.v. thrombolysis from 1/1/2011 to 1/1/2012 in our Stroke Unit. For every patient we evaluated fibrinogen levels pre-thrombolysis and after 2, 6, 12 and 24 hours from t-PA infusion. We studied rate of decrease for every time and we made a trend analysis of fibrinogen serum values during first 24 hours after thrombolysis. Results: The mean age of patients was 69.5 years and the mean baseline NIHSS was 9.0. Mean baseline fibrinogen level was 3.40 g/l with a mean decrease of 21.4% 2-hours after thrombolytic therapy (mean fibrinogen value 2.55 g/l). Until the first 12 hours after thrombolysis fibrinogen levels main-tained very similar values, even if we observed a light further decrease after 6 hours and a light re-growth after 12 hours from t-PA infusion mean fibrinogen value of 2.54 g/l after 6 hours (-21.2%) and of 2.58 g/l after 12 hours (-19.9%). After 24 hour from treatment however it showed a further increase of fibrinogen level mean fibrinogen value after 24 hours: 2.78 g/l (-13.2%). Conclusion: In this study we observed an important mean decrease of fibrinogen levels after thrombolysis. This decrease shows a trend of reduction during first 6 hours and a new increase after 12 hours that be-come more important after 24 hours after fibrinolytic treatment. These results seems confirm the the-ory of a tPA related coagulopathy that caused an hypofibrinogenemia, that could be a risk factor for IH. We recommend to assess fibrinogen level pre- and post-treatment in all thrombolyzed patients. 624 Acute stroke: emergency management, stroke units and complications Audit of stroke admissions at a dual site stroke centre in Sheffield, United Kingdom. N.S. Wilson1, M. Randall2, G. Dunn3, F. Claydon4, K. Endean5, R. Bainbridge6 Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UNITED KINGDOM1, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UNITED KINGDOM2, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UNITED KINGDOM3, Royal Hal-lamshire Hospital, Sheffield Teaching Hospitals, , 4, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UNITED KINGDOM5, Royal Hallamshire Hospital, Sheffield Teaching Hospi-tals, Sheffield, UNITED KINGDOM6 Background: In August 2010 Sheffield Teaching Hospitals opened a new specialist stroke unit. A two site system was created with the Accident and Emergency (A & E) department and the acute stroke service based on separate sites. Delivering patients to the correct unit is a priority. For patient safety transfer guidelines state that any patient with a GCS of ≤8, problems with airway, breathing or circulation, is clinically unstable, symptomatic from an arrhythmia or unresponsive should be triaged to A&E. All other suspected stroke should be triaged correctly direct to the stroke unit using FAST test to receive thrombolysis. This study highlights the problems of clinical triage in non A & E based stroke units. Method: Recent literature, current NICE guidelines and Sheffield Teaching Hospital policies were reviewed. Patients presenting to the Northern General hospital in the period 01/01/11 to 31/12/11 who were subsequently transferred to the stroke unit were initially included in this audit. A data collection tool was designed and approval gained from the audit department. A ran-dom sample of 95 case notes of the 200 within the database were reviewed. Results: 28.4% (27/95) of patients were admitted via 999, had a GCS > 8 on admission and were FAST positive on arrival in A&E. 22 of these patients were diagnosed with an acute ischaemic or haemorrhagic intracerebral event. According to current guidelines, these 27 patients should have been admitted directly to the acute stroke unit. Conclusion: Current transfer guidelines may not be stringent enough as 28.4% of patients were incorrectly admitted to A&E, reducing the opportunity for rapid acute stroke care and thrombolysis. Work is ongoing to examine why this occurred and re-evaluation of current paramedic screening protocols for stroke to ensure all potential stroke patients with a GCS >8 are directly ad-mitted to the stroke unit.
Karger_ESC London_2013
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