Abstract TP356: Through Think and Thin: Hematocrit as a Predictor for Language Recovery in Subacute Aphasia

Introduction: Aphasia is a common and debilitating consequence of ischemic strokes affecting 21%-38% of stroke survivors in the sub-acute phase, with 25%-50% of patients living with chronic symptoms. This pilot study explores the relationship between Hematocrit (Hct) levels and aphasia recovery in subacute patients. Finally, we explore how dual antiplatelet therapies (DAPTs) and continued post-discharge blood monitoring may provide insight into therapeutic targets for language. Methods: Nine male veterans (age 66.9±7.2 years), ~8.1 weeks post-left hemisphere ischemic stroke with aphasia, were recruited from the Atlanta VA Hospital. Aphasia severity was assessed using the Western Aphasia Battery-Revised (WAB-R). Hemoglobin (Hb) was measured via finger-prick and converted to hematocrit (Hct). Cerebral blood flow (CBF) was measured using 3D pseudo-continuous arterial spin labeling (pCASL) MRI. All measures were repeated at 16 weeks post-stroke. Participants received standard care without study interventions. Linear regression was used to assess relationships between changes in Hct, CBF, and WAB-R scores related to language recovery. Results: A significant positive correlation was found between changes in Hct and WAB-R scores (p = 0.045) (Fig. 1), with one participant moving from low to normal Hct, showing the greatest improvement (+8.7 points). Notably, those individuals on DAPTs showed improved Hct (+9.75%) but reduced WAB-R scores (-0.35), suggesting Hct alone may not show recovery. In addition, we observed increased Hct associated with increased CBF in collateral regions, suggesting increased blood delivery to areas surrounding the lesion and perilesional areas. Conclusion: Our work suggests that Hct levels may play a role in post-stroke aphasia recovery, with increases towards normal levels linked to better language function. However, a reduction in the WAB-R among DAPT participants indicates that significant deviations from the normal Hct range could hinder recovery. This study, which did not introduce interventions, highlights the potential benefits of routine post-discharge blood monitoring to identify treatment opportunities not just to prevent secondary stroke but also to promote long-term functional gains. Our research highlights how standard blood thinners affect language recovery during the subacute stages, offering insights for the need to improve stroke management strategies.