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22. European Stroke Conference 16 Stroke prevention B 17:00 - 17:10 The true cost of warfarin – stroke in patients at risk who are untreated, under-treated or over-treated D.M. Collas1, S.K. Gill2 West Hertfordshire Hospitals NHS Trust, Watford, UNITED KINGDOM1,West Hertford-shire Hospitals NHS Trust, Watford, UNITED KINGDOM2 INTRODUCTION Many strokes occur in patients who despite indications for anticoagulation (a/c) are either un-treated or although on warfarin are outside the therapeutic range. These potentially avoidable events have costly consequences. These costs should be considered when evaluating warfarin against new oral anticoagulants (NOAC). METHOD Data on all strokes in atrial fibrillation (af), and all strokes on a/c for other indications, were extracted from a prospectively collected database of all stroke admissions to a general hospital over a 12 year period (2001 Apr to 2012 Mar). RESULT A total of 5088 patients were on the database - 3652 ischaemic, 561 primary intracerebral haemorrhage (PICH), 135 subarachnoid, 169 extra-axial haemorrhage, 571 TIA. Only 19% (175/918) acute stroke patients in af were on warfarin (mean age 78.7). Only 30% of these (50/167 with known INR) were within the therapeutic range (median INR 2.1) at the time of stroke, 6% overall. In 36 patients warfarin had been discontinued, and in 50% (11/22) where timing was known had been stopped < 1 month prior to the stroke (10 falls, 4 side-effects, 2 falls, 6 reason unknown). Of ischaemic strokes on warfarin 55% had an INR below 2 (median 1.9), including 5/9 patients with prosthetic valves. Of haemorrhagic strokes 57% had an INR over 3 (median 3.5), including 41 PICH, 4 subarachnoid, 13 subdurals. Two newly diagnosed cases of af had a stroke waiting to start a/c. CONCLUSION Only a tiny fraction (6%) of patients known to be at risk from af were effectively protected by a/c at the time of stroke. This reflects reluctance to use warfarin and difficulty using it effective-ly. A high INR in over half the intracranial haemorrhages underlines the difficulty in using it safely, and the reason for the reluctance to use it at all. There are savings to be made in more ef-fective prevention, incorporating newer agents which are safer, more acceptable to patients and doctors, easier to control and of more rapid onset. 15 Stroke prevention B 16:50 - 17:00 Young stroke patients; ‘old’ risk factors K.J.L Kanselaar-Martens1, S Exters-van de Ven2, S Romviel3, E van Dijk4, FE de Leeuw5 Department of Neurology, , Donders Institute for Brain, Cognition and Behaviour, Cen-ter for Neuroscience , Radboud University Nijmegen Medical Center,, Nijmegen, THE NETHERLANDS1,Department of Neurology, , Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience , Radboud University Nijmegen Medical Center,, Nijme-gen, THE NETHERLANDS2, Department of Neurology, , Donders Institute for Brain, Cogni-tion and Behaviour, Center for Neuroscience , Radboud University Nijmegen Medical Center,, Nijmegen, THE NETHERLANDS3, Department of Neurology, , Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience , Radboud University Nijmegen Medical Center,, Nijmegen, THE NETHERLANDS4, Department of Neurology, , Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience , Radboud University Nijmegen Medical Center,, Nijmegen, THE NETHERLANDS5 Background Risk factors for “young’ stroke are traditionally believed to be different from those who suffer a stroke at higher ages. However, there is increasing evidence for a role of, potential treatable, “classical” cardiovascular risk factors, including life-style risk factors such as obesity, dietary habits, smoking in the pathophysiology of young stroke. Objective: To investigate the preva-lence of vascular risk factors in a cohort of young stroke patients Methods All consecutive patients with a stroke (either hemorrhagic or ischemic) or TIA who were admit-ted to the neurological department or visited the TIA-outpatient clinic of the Radboud Universi-ty Nijmegen Medical Center, the Netherlands between 2005 and 2012. Every patient underwent a cardiovascular screening consisting of fasting blood samples ( cholesterol, HDL, LDL, glu-cose) , blood pressure measurements and assessment of weight and length. Results There were 263 young stroke patients. Mean age was 42 years and 54% were female. 29% suf-fered from hypertension (systolic blood pressure > 130 mm Hg and/or diastolic blood pressure > 80 mm Hg and/or the use of blood pressure lowering agents). LDL cholesterol was over 2.5 mmol in 48% and impaired fasting glucose (> 6 mmol/l) in 8% of all patients. 54% Had a BMI over 25 and 26% were current smokers. This risk profile did not differ from elderly stroke pa-tients Only 10% did not suffer from any vascular risk factor at all. Conclusion Young stroke patients suffered equal as much from the traditional vascular risk factors as “el-derly” stroke patients. This challenges the traditional view of more rare causes for young stroke. Patients who develop a young stroke may merely have an increased vulnerability for the “classical” vascular risk factors which result in earlier development of vascular disease in those young patients. It also offers a potential for secondary prevention in a group that has always been excluded from the large secondary prevention trial. 162 © 2013 S. Karger AG, Basel Scientific Programme


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