22. European Stroke Conference 857 Intracerebral/subarachnoid haemorrhage and venous diseases Cerebral Venous Thrombosis in Paroxysmal Nocturnal Hemoglobinuria: a study of 15 cases E. MEPPIEL1, I. CRASSARD2, R. PEFFAULT De LATOUR3, H. CHABRIAT4, G. SOCIE5, M.G. BOUSSER6 Hôpital Lariboisière, Neurologie, PARIS, FRANCE1, Hôpital Lariboisière, Neurologie, PARIS, FRANCE2, Hôpital Saint Louis, Hématologie-Greffe, PARIS, FRANCE3, Hôpital Lariboisière, Neu-rologie, PARIS, FRANCE4, Hôpital Saint Louis, Hématologie-Greffe, PARIS, FRANCE5, Hôpital Lariboisière, Neurologie, PARIS, FRANCE6 Background. In paroxysmal nocturnal hemoglobinuria (PNH), cerebral venous system is the second most frequent location of thrombosis after hepatic veins. Few data are available about PNH-related cerebral venous thrombosis (CVT) because of the rarity of both disorders. We report characteristics of a French cohort. Methods. The study was based on the French Society of Hematology (SFH) co-hort of 465 PNH patients (1950-2005). Among reported cerebral vascular events, patients with MRI diagnosed CVT were included. Other patients were recruited from direct contact with French He-matology Units. PNH-related CVT were compared to the 396 CVT from Lariboisière cohort (1997- 2011). Results. Fifteen PNH patients with CVT were included between 1990 and 2012; 80% (12/15) were women. There was no major difference in clinical and radiological CVT characteristics com-pared with Lariboisière cohort, except for a younger age at diagnosis in PNH patients (p<0,001). Seven patients presented other thrombosis risk factors. Three patients had also hepatic vein throm-bosis. CVT was the first manifestation of PNH in 4 patients. All patients were treated with anti-coagulation therapy. One death occurred in acute stage. All surviving patients were independent (mRS≤2) one year after. Half the patients (7/15) received a specific treatment for PNH (bone mar-row transplantation or eculizumab). Recurrent thrombosis occurred despite vitamin K antagonist in 5 of the 8 patients who did not receive specific treatment for PNH. Cases of death (7/15) were mainly related to hepatic vein thrombosis. Conclusion. PNH remains a rare cause of CVT (0,8% of Lariboisière). There is no special feature except the very young age of the patients. PNH should be investigated in case of idiopathic CVT or if there is anemia and/or thrombopenia. CVT occurrence is a turning point in the evolution of the disease. Parallel to neurological management, PNH treatment should be proposed as soon as possible to avoid recurrent thrombosis. 800 © 2013 S. Karger AG, Basel Scientific Programme 858 Intracerebral/subarachnoid haemorrhage and venous diseases Few patients with intracerebral haemorrhage are eligible for randomised controlled trials: community-based study A.F. Fonville1, N. Samarasekera2, Y.B. Roos3, R. Al-Shahi Salman4 Academic Medical Center, University of Amsterdam, Amsterdam, THE NETHERLANDS1, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UNITED KINGDOM2, Ac-ademic Medical Center, University of Amsterdam, Amsterdam, THE NETHERLANDS3, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UNITED KINGDOM4 BACKGROUND: There are no acute treatments specifically for intracerebral haemorrhage (ICH), but they are being sought in randomised controlled trials (RCTs). The treatment effect sizes in on-going and future RCTs are likely to be small, necessitating large sample sizes, so we estimated the proportion of patients who would be eligible for recent trials of treatments specific for ICH and in-vestigated the main influences on patients’ eligibility. METHODS: We searched the Internet Stroke Center and the U.S. National Institutes of Health RCT registries in February 2012 for RCTs investigating an acute treatment for ICH. We quantified the proportions of patients who were eligible for these RCTs and whose eligibility for them could be as-sessed in one year (2010-11) of a prospective, community-based ICH cohort study. RESULTS: We applied the inclusion and exclusion criteria of 17 RCTs to 166 patients with primary or secondary ICH. The proportions of patients who were eligible for each RCT varied from 0.6% (95% confidence interval CI 0.1 to 3.3) to 40.4% (95% CI 33.2 to 48.0). Fewer patients were eli-gible for RCTs only enrolling patients within 12 hours of ICH onset compared to RCTs with a lon-ger time window (p=0.03), partly because patients or witnesses were able to confirm a known time and date of onset in only 55.4% (95% CI 47.8 to 62.8). Nevertheless at least 66.9% (95% CI 59.4 to 73.6) of the cohort was not eligible for any of the six RCTs in our analysis that were ongoing at the time of this study. CONCLUSION: A large proportion of patients with ICH are ineligible for current RCTs, but with modifications to RCT design these patients might be offered the prospect of a specific treatment. Broadening eligibility criteria and increasing the time limit for enrolment seem to be the two best strategies to do this in future RCTs.
Karger_ESC London_2013
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