Abstract TP73: Transition of ECASS III Results to Clinical Practice: 90 Day Outcomes in a US Cohort

Introduction: ECASS III showed benefit of IV tPA for acute ischemic stroke (AIS) 3-4.5 hr from onset in a select group of patients from Europe, with this extended treatment subsequently recommended by the AHA/ASA. We prospectively enrolled AIS patients treated with IV tPA as this recommendation was being applied in clinical practice, to determine safety and efficacy in a representative cohort from the USA. Methods: Consecutive AIS patients treated with IV tPA at 18 primary stroke centers throughout Maryland were approached and informed consent obtained during hospitalization. Sites ranged from small community hospitals to large academic medical centers. In-hospital and demographic data were obtained from each site’s GWTG database or directly from the medical record. Study personnel blinded to the treatment time window obtained 90 day modified Rankin Scale (mRS) by structured phone interview. Patients were grouped by time to treatment (≤ 3hr vs. 3-4.5hr) and compared for presence of additional exclusion criteria from ECASS III that are not standard practice in the USA for ≤ 3hr (age >80, history of stroke and diabetes, oral anticoagulant treatment, and NIHSS>25). Good functional outcome (mRS 0-1 and 0-2), mortality, and symptomatic intracerebral hemorrhage (sICH) were analyzed. Results: Patients treated 3-4.5hr were somewhat younger (mean age 62.6 vs. 66.6, p=0.06), and had smaller infarcts (median NIHSS 5 vs. 8, p=0.04). There was only partial adherence to the additional ECASS exclusions (Table 1). There were no significant differences by time to treatment in sICH, mortality, or 90 day functional outcome (Table 2). Conclusion: For US patients treated with IV tPA 3-4.5 hr from onset in every day practice, there is no evidence for increased risk or worse outcomes compared to standard treatment up to 3 hr.

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Abstract 11: Comparison Of Various Methods Of Assessment Of Intracranial Collaterals On The Pretreatment Ct-angiograms To Predict Outcomes In Acute Anterior Circulation Ischemic Stroke

Stroke ◽

10.1161/str.44.suppl_1.a11 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

leonard L yeo ◽

benjamin wakerley ◽

Aftab Ahmad ◽

prakash Paliwal ◽

kay ng ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Treatment Time ◽

Scoring Systems ◽

Anterior Circulation ◽

Unaffected Side ◽

Computed Tomographic ◽

Pre Treatment ◽

Iv Tpa

Background: The presence of effective collateral blood flow patterns may influence response to intravenously administered tissue plasminogen activator (IV-tPA) in acute ischemic stroke (AIS). We compared various existing methods of scoring collaterals on the pre-treatment computed tomographic angiogram (CTA) of the brain for a reliable prediction of functional outcome in AIS patients. Methods: Consecutive AIS patients treated with IV-tPA within 4.5 hours of symptom-onset during 2007-2011 were included. Data were collected for demographics, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and stroke subtypes. Intracranial collaterals were evaluated by 2 independent blinded neuroradiologists via 4 predefined criteria- Miteff’s system that grades middle cerebral artery (MCA) collateral branches with respect to the sylvian fissure; Maas system that compares collaterals on the affected hemisphere against the unaffected side; modified Tan’s scale where collaterals in 50% or more of the MCA territory are classified as good; and a 20-point collateral grading scale in regions corresponding to Alberta Stroke Program Early CT score (ASPECTS) methodology. Good functional outcomes at 3-months were determined by modified Rankin scale (mRS) scores of 0-1. Results: CTA was performed in 115 patients with anterior circulation AIS before IV-tPA bolus. Median age 66yrs (range 35-92), 42% males, median NIHSS 19 points (range 3-30) and median onset-to-treatment time 155 minutes. Overall, 52 (45.2%) patients achieved good functional outcome at 3-months. Univariable analysis revealed younger age, absence of diabetes, lower pre-tPA NIHSS scores and good collaterals according to ASPECTS methodology as significantly associated with good functional outcomes. On multivariable logistic regression, only lower NIHSS (OR 1.111 per NIHSS point; 95% CI 1.023-1.206, p=0.013) and good collaterals by ASPECTS methodology (OR 1.117 per point; 95%CI 1.006-1.241, p=0.039) were found as independent predictors of good outcomes. Conclusion: Of the existing intracranial collaterals scoring systems, only the ASPECTS methodology serves as a reliable predictor of favorable outcomes at 3-months in patients with anterior circulation AIS.

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Abstract WP25: Concomitant IV tPA Does Not Increase Harm to Patients Who Receive Simultaneous Mechanical Thrombectomy and Emergent Carotid Artery Stent Treatment

Stroke ◽

10.1161/str.44.suppl_1.awp25 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Hormozd Bozorgchami ◽

Jeremy Fields ◽

Gary Walker ◽

Cindy Jahans ◽

Helmi Lutsep ◽

...

Keyword(s):

Carotid Artery ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Treated Group ◽

Stroke Patients ◽

Time To Treatment ◽

Exact Test ◽

Symptomatic Intracerebral Hemorrhage ◽

Significant Difference ◽

Iv Tpa

Background: Stenting of the cervical internal carotid artery (ICA) may be performed acutely in patients undergoing endovascular intervention for stroke due to occlusion of the intracranial ICA or MCA. It is unclear if pre-intervention IV tPA increases complications of carotid artery stenting (CAS) in this group. Hypothesis: We assessed the hypothesis that pre-intervention IV tPA does not increase the risk of complications in acute ischemic stroke patients (AIS) who require concurrent mechanical thrombectomy and emergent CAS. Methods: Patients undergoing both mechanical thrombectomy and CAS within 24 hours of stroke onset were identified from the Merci Registry, a prospective database of AIS patients treated with the Merci Retriever. Those receiving IV tPA were compared with those that did not for associations with functional independence (mRS 0-2) and risk of symptomatic intracerebral hemorrhage (sICH). The primary endpoint for this study was the percentage of patients with mRS 0-2 at 90 days. Secondary endpoints included 90-day mortality and sICH. Outcomes were compared with Fisher’s exact test. Results: 103 patients were included. Thirty received IV tPA (mean age 59.1, time to treatment 6.3 hrs, median NIHSS 18) and 74 did not (mean age 66.1, time to treatment 9.8 hrs, median NIHSS 16). Although numerically higher, there was no significant difference in sICH at 24 hours, occurring in 18.2% (4/22) of IV tPA patients and 7.3% (4/55) of patients without IV tPA (p=0.22) [sICH data was not available on 28 patients]. At 90 days, 40% of the IV tPA group (12/30) was functionally independent while 30.6% (22/73) was functionally independent in the non-IV tPA group (p=0.36). There was no difference in 90-day mortality between the two groups (26.7% vs. 34.7%, p=0.67). Conclusions: This study demonstrates that concomitant IV tPA use in acute stroke patients who had simultaneous mechanical thrombectomy and CAS did not significantly affect patient outcomes or increase complications. Although neither result was statistically significant, there was a trend toward improved functional outcomes at 90 days in the IV tPA treated group despite a trend toward increased rates of sICH.

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Abstract 3275: Early Neurological Improvement After Intravenous Thrombolysis in Acute Stroke Predicts Long-Term Functional Outcome

Stroke ◽

10.1161/str.43.suppl_1.a3275 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Leonard L Yeo ◽

Liang Shen ◽

Ben Wakerley ◽

Aftab Ahmad ◽

Kay W Ng ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Symptom Onset ◽

Functional Outcomes ◽

Treatment Time ◽

Favorable Outcome ◽

Stroke Patients ◽

Neurological Improvement ◽

Iv Tpa

Background: Intravenously administered tissue plasminogen activator (IV-TPA) remains the only approved therapeutic agent for arterial recanalization in acute ischemic stroke (AIS). Wide variations in the rates and timing of neurological recovery are observed in thrombolyzed patients. While all IV-TPA treated patients are routinely evaluated for neurological recovery at 24-hours, considerable improvement occurs in some cases within 2-hours of treatment initiation. We evaluated whether early neurological improvement at 2-hours after IV-TPA bolus (ENI-2) can predict functional outcomes in thrombolyzed AIS patients at 3-months. Methods: Data for consecutive stroke patients treated with IV-TPA within 4.5 hours of symptom-onset during 2007-2010 were prospectively entered in the thrombolyzed registry maintained at our tertiary care center. Data were collected for demographic characteristics, vascular risk factors, stroke subtypes and blood pressure levels before IV-TPA bolus. National Institute of Health Stroke Scale (NIHSS) scores were obtained before IV-TPA bolus and at 2-hours. ENI-2 was defined as a reduction in NIHSS score by more than 10-points from baseline score or an absolute score of 4-points or less at 2-hours after IV-TPA bolus. Functional outcomes at 3-months were determined by modified Rankin scale (mRS). Data were analyzed by SPSS 19.0. Results: Of the 2238 AIS patients admitted during the study period, 240 (11%) received IV-TPA within 4.5-hours of symptom-onset. Median age was 65yrs (range 19-92), 63% males, median NIHSS 17points (range 3-35) and median onset-to-treatment time 149 minutes. Overall, 122 (50.8%) patients achieved favorable functional outcome (mRS 0-1) at 3-months. Factors associated with favorable outcome at 3-months on univariable analysis were younger age, female gender, presence of atrial fibrillation, baseline NIHSS, onset-to-treatment time (OTT) and ENI-2. However, multivariable analysis demonstrated NIHSS at onset (OR per 1-point increase 0.907, 95%CI 0.848-0.969) and ENI-2 (OR 4.926 95%CI 1.66-15.15) as independent predictors of favorable outcome at 3-months. Conclusion: Early Neurological improvement at 2-hours after IV-TPA bolus is a strong predictor of the functional outcome at 3-months in acute ischemic stroke patients.

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Abstract TMP77: Baseline Nihss-adjusted Time Window For Iv Tpa In Acute Stroke

Stroke ◽

10.1161/str.44.suppl_1.atmp77 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Marian Muchada ◽

Marta Rubiera ◽

Jorge Pagola ◽

David Rodriguez- Luna ◽

Alan A. Flores ◽

...

Keyword(s):

Functional Outcome ◽

Time Window ◽

Favorable Outcome ◽

Minor Stroke ◽

Stroke Severity ◽

Ischemic Lesion ◽

Severe Stroke ◽

Time To Treatment ◽

The Impact ◽

Iv Tpa

Background: Updated metaanalysis have shown that beneficial effect of iv tPA on functional outcome decreases progressively overtime until 4.5 h. However, given the differential pattern of arterial occlusion, stroke severity and speed of ischemic lesion growth among candidates for reperfusion, the time window should be adjusted accordingly. We aim to identify time windows for different categories of stroke severity and occlusion location. Methods: Were included patients treated according to the criteria of the European Summary of Product Characteristics for alteplase treatment < 4.5h in a Universitary Hospital from 2001- 2011. Patients were grouped according to NIHSS severity in minor NIHSS ≤ 8, moderate stroke NIHSS 9-15, severe stroke NIHSS ≥ 16. We sequentially analyzed time-to-treatment to achieve favorable outcome as mRS ≤ 2 at 3 months. Results: 640 patients were included, of whom 123 patients (19.22%) with minor stroke, 205 (32.5%) with moderate stroke and 312 (48.75%) with severe stroke. The rate of favorable outcome was 79.8%, 62.5%, 24.2% respectively. In patients with minor stroke time-to-treatment did not predict outcome (OR 1.005, 95% CI: 0.997- 1.012; p = 0.264). After adjusting for age and occlusion location only age was a independent variable (OR 1.198; 95% CI: 1.054-1.336; p= 0.001). In patients with moderate stroke time-to-treatment ≤ 240 minutes predict favorable outcome (OR 0.041, 95% CI 0.160- 0.962; p= 0.041), although only age and occlusion location, were independent predictors: (OR 1.061, 95% CI 1.024- 1.098; p= 0.001) and (OR 2.968, 95% CI 1.293- 6.614; p= 0.010), respectively. In patients with severe stroke time-to-treatment ≤ 90 minutes predict favorable outcome (OR 0.428, 95% CI 0.186-0.985; p= 0.046). Adjusting for proximal occlusion, age and time-to-treatment before 90 minutes were independent variables: age (OR 1.045, 95% CI 1.014-1.077, p= 0.004) and time-to-treatment (OR 0.267, 95% CI 0.088- 0.809, p= 0.020) Conclusions: The impact of time-to-treatment on favorable outcome varies widely depending on baseline stroke severity. The window for favorable outcome was <90min for severe strokes and extends to <240min in moderate stokes. However, time-to-treatment appeared unrelated to functional outcome in minor stroke.

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Abstract P37: A Novel Emergency Stroke Alert System Reduces Door-to-CT And Door-to-Needle Time in Patients With Acute Ischemic Stroke

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap37 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Muhammad A Pervez ◽

Joshua N Goldstein ◽

Natalia S Rost ◽

Joyce Mclntyre ◽

Joseph Fay ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Stroke Care ◽

National Guidelines ◽

Alert System ◽

Acute Stroke Care ◽

Post Intervention ◽

Symptomatic Intracerebral Hemorrhage ◽

Increased Risk ◽

Iv Tpa

Background: National guidelines recommend eligible acute stroke patients undergo neuroimaging within 25 min and IV tPA within 60 min. In order to reduce door-to-needle time, we implemented an “ED2CT” virtual group pager which allows ED staff to simultaneously activate the Stroke Team, neuroradiologists, CT technologists, nursing supervisors and pharmacists. Methods: We performed an IRB approved retrospective review of a prospectively acquired cohort of consecutive patients with ischemic stroke presenting to a single tertiary stroke center using our Get With the Guidelines Stroke (GWTG-S) database. We compared patients who received IV tPA within 3 hours of symptom onset pre- (March 2006-April 2008) to post-intervention (September 2008-December 2009) by Wilcoxon or Fisher's exact as appropriate. Results: Overall, there were 56 patients in the pre-intervention and 53 in the post-intervention groups. Patients were 50.5% male, median age was 76 [IQR 63, 85] years, median time to presentation was 50 [IQR 33, 87] min, and median initial NIHSS was 14 [IQR 8, 20]. None of these variables were significantly different between the pre- and post-intervention groups. Implementation of the ED2CT alert was associated with a reduction of 31% in door-to-CT time (29 [22, 40] vs. 20 [16, 29] min; p=<0.001) and 13.5% in door-to needle time (59 [42, 78] vs. 51 [35, 62] min; p=0.02). In addition, there was an increase of 55% in the proportion of patients undergoing CT within 25 min (42.9% vs.66.7 % p=0.01) and 39% in door-to needle within 60 min (51.8% vs. 72.0% p=0.03). Symptomatic intracerebral hemorrhage (sICH) was infrequent among patients receiving IV tPA with or without rescue IA reperfusion (n=109, 8.3%) and those with IV tPA only (n=83, 6.0%); there was a trend in reduced sICH rate post intervention (11.6% vs. 0%; p=0.06). Conclusions: A novel emergency alert system with which the ED attending directly activates multiple members of the acute stroke clinical and imaging team was associated with an improved door-CT time and improved door-tPA time without an increased risk of sICH. This approach aligns acute stroke care activation with trauma and emergency cardiac care and suggests that team-based approaches may be better than specialty -specific responses.

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Efficacy and safety of intravenous recombinant tissue plasminogen activator in mild ischaemic stroke: a meta-analysis

Stroke and Vascular Neurology ◽

10.1136/svn-2017-000106 ◽

2018 ◽

Vol 3 (1) ◽

pp. 22-27 ◽

Cited By ~ 12

Author(s):

Shoujiang You ◽

Anubhav Saxena ◽

Xia Wang ◽

WeeYong Tan ◽

Qiao Han ◽

...

Keyword(s):

Ischaemic Stroke ◽

Functional Outcome ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Meta Analysis ◽

Recombinant Tissue Plasminogen Activator ◽

Efficacy And Safety ◽

Increased Risk ◽

Tissue Plasminogen ◽

Iv Tpa

The benefits and safety of intravenous recombinant tissue plasminogen activator (IV-tPA) for patients with mild ischaemic stroke (MIS) are still unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients with MIS. We performed a systematic literature search across MEDLINE, Embase, Central, Global Health and Cumulative Index to Nursing and Allied Health Literature (CINAHL) , from inception to 10 November 2016, to identify all related studies. Where possible, data were pooled for meta-analysis with odds ratio (OR) and corresponding 95% confidence interval (CI) using the fixed-effects model. MIS was defined as having National Institutes of Health Stroke Scale score of ≤6. We included seven studies with a total of 1591 patients based on the prespecified inclusion and exclusion criteria. The meta-analysis indicated a high odds of excellent functional outcome based on the modified Rankin Scale or Oxfordshire Handicap Score 0–1 (OR=1.43; 95% CI 1.14 to 1.79; P=0.002, I2=35%) in patients treated with IV-tPA compared with those not treated with IV-tPA (74.8% vs 67.6%). There was a high risk of symptomatic intracranial haemorrhage (sICH) with IV-tPA treatment (OR=10.13; 95% CI 1.93 to 53.02; P=0.006, I2=0%) (1.9% vs 0.0%) but not mortality (OR=0.78; 95% CI 0.43 to 1.43; P=0.43, I2=0%) (2.4% vs 2.9%). Treatment with IV-tPA was associated with better functional outcome but not mortality among patients with MIS, although there was an increased risk of sICH. Randomised trials are warranted to confirm these findings.

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Abstract W P35: Assessment of Collaterals on Day-2 CT Angiography Can Predict Functional Outcome in Thrombolyzed Anterior Circulation Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wp35 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

leonard L yeo ◽

Prakash Paliwal ◽

Hock Luen Teoh ◽

Raymond C Seet ◽

Bernard P Chan ◽

...

Keyword(s):

Functional Outcome ◽

Ct Angiography ◽

Treatment Time ◽

Multivariable Analysis ◽

Favourable Outcome ◽

Anterior Circulation ◽

Good Functional Outcome ◽

Intravenous Tissue Plasminogen Activator ◽

Younger Age ◽

Iv Tpa

Background: Several methods exist that assess the intracranial collaterals on CT-angiography (CTA) of the brain. We compared existing methods for quantification of collaterals on day-2 CTA in thrombolyzed AIS patients to assess their predictive value for functional outcome. Methods: Consecutive AIS patients treated with intravenous tissue plasminogen activator (IV-tPA) during 2007-2012 were included. Data were collected for demographics, vascular risk factors, NIHSS scores and stroke subtypes. Intracranial collaterals were evaluated by 2 independent neuroradiologists using 4 existing methods- Miteff’s system (grades middle cerebral artery (MCA) collateral branches with respect to sylvian fissure); Maas system (compares collaterals in affected hemisphere against the contralateral side); Modified Tan’s scale (collaterals in 50% or more of MCA territory classified as good); and 20-point collateral grading scale by Alberta Stroke Program Early CT score (ASPECTS) methodology. Good functional outcome at 3-months was determined by modified Rankin scale (mRS) scores of 0-1. Results: Day-2 CTA was performed in 150 patients with anterior circulation AIS treated with IV-tPA. Median age 66yrs (range 33-92), 47% males, median NIHSS 19 points (range 4-34) and median onset-to-treatment time 165 minutes (range 74-274). Overall, 67 (44.6%) patients achieved good functional outcome at 3-months. On univariable analysis- younger age, lower pre-tPA NIHSS scores, atrial fibrillation, good collaterals according to ASPECTS scoring and good collaterals by Maas methodology were significantly associated with good functional outcome. On multivariable analysis, lower NIHSS (OR 1.155 per NIHSS point; 95% CI 1.066-1.251, p=0.001), younger age (OR 1.052 per year; 95% CI 1.012-1.094, p=0.010), good collaterals by Maas methodology (OR 2.805 95% CI 1.122 -7.011, p =0.002) and good collaterals (score of 9 or more) by ASPECTS methodology (OR 3.769 ; 95%CI: 1.327- 10.708, p= 0.013 ) were found as independent predictors of good outcome. Conclusion: Of the existing intracranial collaterals scoring systems, only the ASPECTS and Maas methods are reliable predictor of favourable outcome in thrombolyzed anterior circulation AIS patients.

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Preventive Ceftriaxone in Patients with Stroke Treated with Intravenous Thrombolysis: Post Hoc Analysis of the Preventive Antibiotics in Stroke Study

Cerebrovascular Diseases ◽

10.1159/000446160 ◽

2016 ◽

Vol 42 (5-6) ◽

pp. 361-369 ◽

Cited By ~ 8

Author(s):

Jan-Dirk Vermeij ◽

Willeke F. Westendorp ◽

Yvo B. Roos ◽

Matthijs C. Brouwer ◽

Diederik van de Beek ◽

...

Keyword(s):

Acute Stroke ◽

Functional Outcome ◽

Intravenous Thrombolysis ◽

Control Group ◽

P Value ◽

Post Hoc Analysis ◽

Symptomatic Intracerebral Hemorrhage ◽

Stroke Study ◽

Increased Risk ◽

Post Hoc

Background: The Preventive Antibiotics in Stroke Study (PASS), a randomized open-label masked endpoint trial, showed that preventive ceftriaxone did not improve functional outcome at 3 months in patients with acute stroke (adjusted common OR 0.95; 95% CI 0.82-1.09). Post-hoc analyses showed that among patients who received intravenous thrombolysis (IVT), patients who received ceftriaxone had a significantly better outcome as compared with the control group. This study aimed to gain more insight into the characteristics of these patients. Methods: In PASS, 2,550 patients were randomly assigned to preventive antibiotic treatment with ceftriaxone or standard care. In current post-hoc analysis, 836 patients who received IVT were included. Primary outcome included functional status on the modified Rankin Scale, analyzed with adjusted ordinal regression. Secondary outcomes included infection rate and symptomatic intracerebral hemorrhage (sICH) rate. Results: For all patients in PASS, the p value for the interaction between IVT and preventive ceftriaxone regarding functional outcome was 0.03. Of the 836 IVT-treated patients, 437 were administered ceftriaxone and 399 were allocated to the control group. Baseline characteristics were similar. In the IVT subgroup, preventive ceftriaxone was associated with a significant reduction in unfavorable outcome (adjusted common OR 0.77; 95% CI 0.61-0.99; p = 0.04). Mortality at 3 months was similar (OR 0.75; 95% CI 0.48-1.18). Preventive ceftriaxone was associated with a reduction in infections (OR 0.43; 95% CI 0.28-0.66), and a trend towards an increased risk for sICH (OR 3.09; 95% CI 0.85-11.31). Timing of ceftriaxone administration did not influence the outcome (aOR 1.00; 95% CI 0.98-1.03; p = 0.85). Conclusions: According to the post-hoc analysis of PASS, preventive ceftriaxone may improve the functional outcome in IVT-treated patients with acute stroke, despite a trend towards an increased rate of post-IVT-sICH.

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Abstract TP56: The Impact of Early Ischemic Changes on Head CT on Hemorrhagic Conversion and Outcomes in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.47.suppl_1.tp56 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Ayaz Khawaja ◽

Karen Albright ◽

Angela Hays Shapshak ◽

Harn Shiue ◽

April Sisson ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Hemorrhagic Transformation ◽

Poor Functional Outcome ◽

Head Ct ◽

Increased Risk ◽

The Impact ◽

Iv Tpa

Background: Early ischemic changes (EIC) on head CT are associated with increased hemorrhagic transformation (HT) following treatment with TPA. We examined the associations between EIC, HT, and outcomes in patients treated and not treated with IV TPA. Methods: We conducted a retrospective review of consecutive acute ischemic stroke (AIS) patients presenting to our CSC from April 2014 to March 2015. Demographic and clinical data, including initial head CT findings (parenchymal hypodensity, loss of gray-white differentiation, sulcal effacement, hyperdense vessel) were collected. HT on repeat neuroimaging, poor functional outcome, as measured by a modified Rankin Scale (mRS) of 3-6, and in-hospital mortality were assessed. Results: A total of 679 patients were included (50.4% men). One hundred and eight patients (15.9%) received IV TPA. EIC were observed in 38.5% of untreated patients and 17.6% in IV TPA treated patients (p<0.0001). For patients treated with IV TPA, EIC was seen more frequently in patients with pre-stroke anticoagulant use (26.3% vs. 6.7%, p=0.010) and less frequently in patients with pre-stroke statin use (15.8% vs. 43.3%, p=0.025). A higher proportion of HT was observed in patients with EIC (12.8% vs. 6.8%, p=0.016 untreated, 36.8% vs. 14.6%, p=0.024 IV TPA) and with hyperdense artery sign (8.2% vs. 3.7%, p=0.022 untreated, 36.8% vs. 15.7%, p=0.035 IV TPA). For untreated patients, EIC was observed in a larger proportion of patients with an NIHSS>14 (14.8% vs. 9.6%, p=0.016), and discharge mRS 3-6 (53.6% vs. 44.5%, p=0.040). For patients treated with IV TPA, in-hospital mortality was more common in patients with EIC (31.6% vs. 10.0%, p=0.013). Conclusions: In untreated patients, EIC may serve as a harbinger for HT on repeat imaging and poor functional outcome at discharge, whereas in patients treated with IV TPA, it is associated with HT and in-hospital mortality. Patients with EIC may be at increased risk of HT and poor outcomes even without thrombolytics.

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Prognostic value of absolute monocyte count in chronic lymphocytic leukaemia

Orvosi Hetilap ◽

10.1556/oh.2015.30126 ◽

2015 ◽

Vol 156 (15) ◽

pp. 592-597

Author(s):

László Szerafin ◽

János Jakó ◽

Ferenc Riskó

Keyword(s):

Chronic Lymphocytic Leukaemia ◽

Prognostic Value ◽

Lymphocytic Leukaemia ◽

Treatment Time ◽

Monocyte Count ◽

Time To Treatment ◽

Causes Of Mortality ◽

The Absolute ◽

The Impact ◽

Overal Survival

Introduction: The low peripheral absolute lymphocyte and high monocyte count have been reported to correlate with poor clinical outcome in various lymphomas and other cancers. However, a few data known about the prognostic value of absolute monocyte count in chronic lymphocytic leukaemia. Aim: The aim of the authors was to investigate the impact of absolute monocyte count measured at the time of diagnosis in patients with chronic lymphocytic leukaemia on the time to treatment and overal survival. Method: Between January 1, 2005 and December 31, 2012, 223 patients with newly-diagnosed chronic lymphocytic leukaemia were included. The rate of patients needing treatment, time to treatment, overal survival and causes of mortality based on Rai stages, CD38, ZAP-70 positivity and absolute monocyte count were analyzed. Results: Therapy was necessary in 21.1%, 57.4%, 88.9%, 88.9% and 100% of patients in Rai stage 0, I, II, III an IV, respectively; in 61.9% and 60.8% of patients exhibiting CD38 and ZAP-70 positivity, respectively; and in 76.9%, 21.2% and 66.2% of patients if the absolute monocyte count was <0.25 G/l, between 0.25–0.75 G/l and >0.75 G/l, respectively. The median time to treatment and the median overal survival were 19.5, 65, and 35.5 months; and 41.5, 65, and 49.5 months according to the three groups of monocyte counts. The relative risk of beginning the therapy was 1.62 (p<0.01) in patients with absolute monocyte count <0.25 G/l or >0.75 G/l, as compared to those with 0.25–0.75 G/l, and the risk of overal survival was 2.41 (p<0.01) in patients with absolute monocyte count lower than 0.25 G/l as compared to those with higher than 0.25 G/l. The relative risks remained significant in Rai 0 patients, too. The leading causes of mortality were infections (41.7%) and the chronic lymphocytic leukaemia (58.3%) in patients with low monocyte count, while tumours (25.9–35.3%) and other events (48.1 and11.8%) occurred in patients with medium or high monocyte counts. Conclusions: Patients with low and high monocyte counts had a shorter time to treatment compared to patients who belonged to the intermediate monocyte count group. The low absolute monocyte count was associated with increased mortality caused by infectious complications and chronic lymphocytic leukaemia. The absolute monocyte count may give additional prognostic information in Rai stage 0, too. Orv. Hetil., 2015, 156(15), 592–597.

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