22. European Stroke Conference 9 Meta-analysis and reviews 17:50 - 18:00 Newly detected paroxysmal atrial fibrillation after TIA and ischaemic stroke on cardiac monitoring: systematic review and meta-analysis in relation to duration of recording G.S.C. Yiin1, P.M. Rothwell2 Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, Univer-sity of Oxford, Oxford, UNITED KINGDOM1,Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UNITED KINGDOM2 BACKGROUND: Current evidence suggests that prolonged cardiac monitoring after cere-bral ischaemia to detect paroxysmal atrial fibrillation (pAF) is likely to be cost effective, but the optimal duration of monitoring remains unclear. METHODS: We performed a systematic review (studies published to December 2012) of all prospective and retrospective studies of rates of pAF early after TIA or ischaemic stroke in which consecutive patients underwent >12 hour cardiac monitoring, including unpublished data from the Oxford Vascular Study. Pooled estimates of rates of newly detected pAF were stratified by monitoring type and duration, study type, publication year and pre-defined pAF duration (any or ≥30sec). RESULTS: Among 19 retrospective and 21 prospective studies, the pooled rate of newly detected AF was 8.3% (851/10283; 95% CI 6.7-9.9, phet<0.0001). The rate tended to be higher in selected vs unse-lected populations (9.9%, 6.0-13.8 vs 7.9%, 6.2-9.5), but was unrelated to year of publication, and was similar in studies in which a duration of pAF ≥30sec was required (8.6%, 6.3-11.0). However, duration of monitoring was the main determinant of the observed rate of pAF, ac-counting for 72% of all heterogeneity between studies in unselected populations. In stratified analyses, the rate of pAF among studies of unselected populations initially increased with dura-tion of recording but plateaued at 5-7 days of monitoring (14.6%, 11.4-17.9, phet.=0.22), with no additional AF detected with 8-30 days of monitoring (13.7%, 9.8-17.5, phet.=0.17). Overall, 76.8% of patients with new pAF ≥30sec were subsequently anticoagulated. CONCLUSION: Cardiac monitoring after TIA or ischaemic stroke detects clinically important rates of pAF in studies of unselected populations, with high rates of subsequent anticoagulation. A monitoring period of 5-7 days appears to be adequate. 8 Meta-analysis and reviews 17:40 - 17:50 Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic em-bolism in patients with atrial fibrillation: Results from a Cochrane systematic review K.M.H. Bruins Slot1, E. Berge2 Oslo University Hospital, Oslo, NORWAY1,Oslo University Hospital, Oslo, NORWAY2 Background Anticoagulant treatment with vitamin K antagonists (VKAs) is effective in preventing throm-boembolic complications in patients with atrial fibrillation (AF). Factor Xa inhibitors appear to have several pharmacological and practical advantages over VKAs. Methods We performed a systematic review of randomised-controlled trials that directly compared the effects of long-term treatment with factor Xa inhibitors and VKAs for the prevention of cere-bral and systemic embolism in patients with AF. We used a fixed-effect model to calculate a weighted estimate of the treatment effect across trials, using odds ratio (OR) with 95% confi-dence intervals (CI). However, in case of significant heterogeneity, we used a random-effects model. Results We included data from 42 084 patients randomised into ten clinical trials. The included trials directly compared dose-adjusted warfarin with either apixaban, betrixaban, darexaban, edox-aban, idraparinux or rivaroxaban. Treatment with a factor Xa inhibitor significantly decreased the number of strokes and systemic embolice events compared with dose-adjusted warfarin (OR 0.81, 95% CI 0.72 to 0.91), as well as the number of all-cause deaths (OR 0.88, 95% 0.81 to 0.97). Factor Xa inhibitor treatment also significantly reduced the number of major bleedings (defined by modified ISTH-criteria) compared with warfarin (OR 0.90, 95% CI 0.82 to 0.99). There was, however, statistically significant and high heterogeneity (I2=82%), and an analysis using a random-effects model did not show a statistically significant decrease in the number of major bleedings (OR 1.01, 95% CI 0.69 to 1.46). Conclusions In patients with AF, factor Xa inhibitors significantly reduce the number of strokes and system-ic embolic events, and all-cause deaths, compared with warfarin. Factor Xa inhibitors also seem to reduce the number of major bleedings compared with warfarin, though the evidence for this is somewhat less robust. 160 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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