London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 699 666 Acute stroke: clinical patterns and practice Enrolling Patients in an Acute Stroke Clinical Trial During the Witching Hours A. Ahluwalia1, S. Starkman2, N. Sanossian3, D. Liebeskind4, L. Ali5, L. Restrepo6 , M.A. Kim-Tenser, M. Valdes-Sueiras, A. Yallapragada, M. Eckstein, F. D. Pratt, J.L. Saver on behalf FAST-MAG Investigators and Coordinators University of California Los Angeles, Los Angeles, USA1, University of California Los Angeles, Los Angeles, USA2, University of California Los Angeles, Los Angeles, USA3, University of Cali-fornia Los Angeles, Los Angeles, USA4, University of California Los Angeles, Los Angeles, USA5, University of California Los Angeles, Los Angeles, USA6 Background: Acute stroke clinical trials frequently enroll patients around the clock, but maintaining enrolling team availability in late evening early morning hours is logistically challenging. The proportion of patients available in these hours and their comparability to daytime patients has not been extensively investigated. We describe the patients enrolled between 22:00-6:59 in the recently completed mul-ticenter prehospital treatment trial, the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) study. Methods: We analyzed the times of enrollment for all 1700 patients enrolled in FAST-MAG. FAST-MAG is a Phase 3, NIH-funded, randomized, double-blind, placebo-controlled study of field-administered magnesium sulfate in stroke patients presenting within 2 hours of symptom onset. Patients could be enrolled 24/7/365. Results: Of the 1700 patients enrolled in FAST-MAG, 235 (13.8%) were enrolled between the hours of 22:00 and 6:59. Compared with patients enrolled outside this time window, patients enrolled between 22:00-6:59 had very similar mean age (69 vs. 70, p=0.74), Hispanic ethnicity frequency (24% vs. 23%, p=0.74), and proportion of racially white patients (79% vs. 78%, p=0.73) but were less likely women (34% vs. 43%, p=.0096). Further, patients enrolled during the late hours had comparable stroke severity (NIHSS 12 vs. 11, p=0.64), ED arrival time (35 min vs. 33 min, p=0.1), and frequen-cy of intracerebral hemorrhage (22% vs. 22%). Conclusion: Patients enrolled between the hours of 22:00 and 6:59 account for slightly more than 1 in 10 patients enrolled in this hyperacute stroke treatment trial. While patients enrolled during the late hours had a slightly lower portion of women represented, all other baseline and stroke characteristics were the same. The low proportion of enrollments and lack of distinct clinical characteristics suggests a de-creased urgency in the inclusion of this subgroup in clinical trials. 667 Acute stroke: clinical patterns and practice The effect of age on haemoglobin concentration in a population undergoing intravenous thrombolysis. R. Ni Donacha1, R. Briggs2, O. Mahon3, G. Kavanagh4, J.A. Harbison5 Trinity College Dublin, Dublin, IRELAND1, Trinity College Dublin, Dublin, IRELAND2, St James’s Hospital, Dublin, IRELAND3, St James’s Hospital, Dublin, IRELAND4, Trinity College Dublin, Dublin, IRELAND5 Introduction: Increasing familiarity and confidence with the use of rT-PA to thrombolyse patients with acute ischaemic stroke has led to a greater number of older people being treated. This change is supported by the publication of the IST-3 trial. Efforts to reduce door to needle time have also meant that many centres routinely begin their rT-PA infusions prior to the receipt of full haematolo-gy results in subjects with no history od blood disorders or anti coagulation. Older subjects are more likely to have undiagnosed anaemia and are also more likely to have occult blood loss from gastro-intestinal sources. We have noticed that some patients suffer a small drop in haemoglobin concentra-tion following lysis so we performed a study to characterise this and determine if it merited further investigation. Methods. Data for baseline, day one and day two post thrombolysis haemoglobin (Hb) was collected for consecutive thrombolysed patients to determine the prevalence of anaemia at baseline and ex-tent of Hb drop. Data on, non thrombolysed, age and gender matched controls with ischaemic stroke were collected for comparison in a 1:2 ratio. Results.45 cases and 90 controls were studied, median 78 years. Mean admission Hb was 13.6 g/ dL and there was no difference between cases and controls (13.6 vs 13.3 p=0.2). No patient throm-bolysed had an admission Hb <10.0g/dL (range 10.4-16.8) but admission Hb correlated inversely with age (r=-0.327, p=0.03). At day 1 Hb dropped by a mean of 0.70g/dL in the patients but also by 0.44g/dL in controls (p=0.14). 7 patients (16%) had a Hb drop >/= 1.5g/dL but only one sub-ject dropped their Hb below 10g/dL. There was no significant correlation between Hb drop and age (r=0.16). At day 2, mean Hb recovered in cases by 0.26g/dL but not in controls (-0.1 g/dL, p=0.02). Conclusions: Thrombolysis is associated with a small drop in Hb at day 1 but this is not significant when compared with controls. Older people do not suffer a greater drop in Hb.
Karger_ESC London_2013
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