22. European Stroke Conference 6 Acute stroke: clinical patterns and practice 17:20 - 17:30 The role of pre-existing disability in patients treated with intravenous thrombolysis for acute stroke M.A. Karlinski1, A. Kobayashi2, A. Członkowska3, R. Mikulik4, M. Brozman5, V. Svigelj6, L. Csiba7, K. Fekete8, J. Korv9, V. Demarin10, D. Jatuzis11, A. Vilionskis12, N. Ahmed13, N. Wahlgren14 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, PO-LAND1, Interventional Stroke Treatment Centre, Institute of Psychiatry and Neurology, War-saw, POLAND2, 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, POLAND3, International Clinical Research Center - Neurology Department, St. Anne´s Hos-pital in Brno, Brno, CZECH REPUBLIC4, Neurology Department, University Hospital Nitra, Nitra, SLOVAKIA5, Department of Vascular Neurology and Neurological Intensive Care, Uni-versity Medical Centre, Ljunlana, SLOVENIA6, Department of Neurology, Medical and Health Science Center, University of Debrecen, Debrecen, HUNGARY7, Department of Neurology, Medical and Health Science Center, University of Debrecen, Debrecen, HUNGARY8, Depart-ment of Neurology and Neurosurgery, University of Tartu, Tartu, ESTONIA9, Department of Neurology, Sestre Milosrdnice University Hospital Centre, Zabreb, CROATIA10, Department of Neurology and Neurosurgery, Vilnius University Hospital, Vilnius, LITHUA-NIA11, Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Vilnius, LITHUANIA12, Department of Neurology, Karolinska University Hospital, Karolinska Institute,, Stockholm, SWEDEN13, Department of Neurology, Karolinska University Hospital, Karolinska Institute, Stockholm, SWEDEN14 Background: Patients with pre-stroke disability are often excluded from intravenous throm-bolysis. Therefore, little is known about the effect of the treatment in this group. Our aim was to evaluate patients’ profile and outcome according to the level of pre-existing disability in patients receiving intravenous trombolysis for stroke. Methods: We analyzed the data of all pa-tients treated with alteplase between October 2003 and December 2011, contributed to the Safe Implementation of Thrombolysis for Stroke - Eastern Europe. We distinguished the following groups: 1) no disability at all (modified Rankin Scale score (mRS) 0, reference); 2) no signifi-cant disability (mRS 1); 3) slight disability (mRS 2); 4) at least moderate disability (mRS ≥3). Results: Of 7250 patients 5995 (82%) had pre-stroke mRS 0, 791 (11%) had mRS 1, 293 (4%) had mRS 2 and 171 (2%) had mRS ≥3. Compared to the no disability group, patients from groups 2 to 4 were significantly older (67, 72, 75, 75 years, respectively), more frequently had comorbidities and had more severe strokes. The rate of symptomatic intracranial haemorrhage (sICH) according to ECASS II definition was 5%, 8%, 7%, and 11%, but the association with pre-stroke disability was not significant in the multivariate analysis. Patients from groups 2 to 4 had higher odds for death at 3 months (OR 1.3, 2.0, 2.6). The odds for neurological improve-ment (≥4 pts in the NIHSS at day 7) were lower in groups 3 and 4 (OR 0.6, both). Patients from group 2 were less likely (OR 0.7) to achieve a composite endpoint of mRS 0-1 or maintaining the baseline mRS at 3 months. Conclusion: Pre-stroke disability in patients treated with intra-venous alteplase does not seem to independently increase the risk of sICH. However, it may be associated with lesser neurological improvement and higher mortality, partially due to worse medical condition. Those patients may require additional risk stratification, but should not be routinely excluded from the therapy. 5 Acute stroke: clinical patterns and practice 17:10 - 17:20 Predictors of anticoagulant prescribing in Glasgow stroke survivors with atrial fibrillation – a registry based analysis T.J. Quinn1, C Young2, S Wong3, C McAlpine4 University of Glasgow, Glasgow, UNITED KINGDOM1,NHS Greater Glasgow and Clyde, Glasgow, UNITED KINGDOM2, University of Glasgow, Glasgow, UNITED KINGDOM3, NHS Greater Glasgow and Clyde, Glasgow, UNITED KINGDOM4 Background Risk of stroke related to atrial fibrillation (AF) is substantial. Risk can be quantified, CHADS2 and CHA2DS2-VASc tools estimate risk, the strongest predictor of stroke is history of previous stroke and stroke survivors with AF should be anticoagulated. We sought to describe anticoagu-lation prescribing patterns across Glasgow in stroke survivors with AF. Methods We used General Practice (GP) data. As part of the Local Enhanced Service, GPs perform detailed annual reviews. We collected data, including vascular risk factors; comorbidity; dis-ability; history of alcohol or bleeding and bleeding risk (HASBLED score). We described so-cio- economic status using Scottish Index of Multiple Deprivation (SIMD); we described stroke risk using CHADS2 and CHA2DS2-VASc. Associations with anticoagulation were described using univariate and multivariate analyses. Given the multiple analyses we chose a significance level of p<0.001. Results Data were available for 3429 stroke survivors with AF; 1699 (49%) male; median age 78 (IQR:72-84). Median CHA2DS2-VASc was 5 (IQR:4-6). Anticoagulation (warfarin) was prescribed in 1165 (34%). Univariate analysis suggested younger age; higher socioeconomic status; history of depression; smoking; obesity and no disability were associated with anticoag-ulation prescription (p<0.001). Risk of bleeding was not associated with anticoagulation. Those with higher CHADS2 and CHA2DS2-VASc scores were less likely to be prescribed anticoagu-lation (p<0.001). On multivariate analysis only age; depression and SIMD were independently associated with anticoagulation prescription. Conclusion AF is prevalent in community dwelling stroke survivors and is undertreated. In this population at high risk of stroke, risk factors for future stroke were not clearly associated with anticoagula-tion. Those at highest risk were less likely to be treated. Further work should describes barriers to anticoagulation and attempt to improve anticoagulation rates. 170 © 2013 S. Karger AG, Basel Scientific Programme
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