London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 489 382 Heart and brain ANTICOAGULATION IN PATIENTS WITH ATRIAL FIBRILLATION AND ACUTE STROKE: WHAT DO WE DO WRONG IN CLINICAL PRACTICE? L. Castilla-Guerra1, M.C. Fernandez-Moreno2, M. Romera Tellado3, A. Tena Martinez4, L. Serrano Rodriguez5, J.P. Verdugo Dominguez6, M.D. Jimenez-Hernandez7, J.M. López-Chozas8, J Marin Martin9 Department of Internal Medicine. Hospital de la Merced, Seville, SPAIN1, Department of Neu-rology. Hospital de Valme, Seville, SPAIN2, Department of Neurology. Hospital de Valme, Seville, SPAIN3, Department of Internal Medicine. Hospital de la Merced, Osuna. Seville., SPAIN4, Depart-ment of Internal Medicine. Hospital de la Merced, Osuna, Seville, SPAIN5, Department of Internal Medicine. Hospital de la Merced, Osuna. Seville., SPAIN6, Department of Neurology.Hospital Vir-gen del Rocio, Seville, SPAIN7, Depatment of Internal Medicine. Hospital Viren del Rocio, Seville, SPAIN8, Department of Internal Medicine. Hospital de la Merced, Osuna. Seville, SPAIN9 Background: Many limitations are associated with the use of traditional oral anticoagulants (OAC) in patients with atrial fibrillation (AF). Often we see patients admitted to hospitals with acute stroke who have AF receiving OAC. We aimed to compare the levels of anticoagulation of these patients with stroke-free patients in the community. Methods: We made a three years retrospective study of patients with AF receiving OAC who were admitted to our hospital after suffering a stroke. They were compared with a control group of stroke-free pa-tients with AF receiving OAC in the community setting. Results: We reviewed 492 stroke patients, of these 49 (9.9%) had AF, however only 28 patients (5.7%) (23 ischemic and 5 hemorrhagic strokes) received OAC before admission. Ninety patients were used as controls. The mean age and sex of both groups were similar: 75.6 (SD 12) vs 75.6 (SD 9) years and half were men in both groups (p-NS-not significant). In relation to the levels of anticoagulation, the mean INR (International Normalized Ratio) before admission was 2.3 (SD 0.4) vs 2.5 (SD 0.2) (stroke vs. controls, p = 0.001) and the time in therapeutic range (TRT) in the previous year was on average 6.2 vs 7 months (p = NS). If we look at subgroups, in ischemic strokes the mean INR was 2.3 (SD 0.4) vs 2.5 (SD 0.2) (p = 0.0001) and the TRT in the previous year was on average 6.5 vs. 7 months (p = NS). Regarding hemorrhagic strokes, the mean INR was 2.4 (SD 0.8) vs 2.5 (SD 0.2) (p = NS) and the TRT in the previous year was mean 4.8 vs 7 months (p = 0.031). Conclusions: Stroke patients showed significantly worse anticoagulation control than those from community set-ting. Patients with ischemic stroke had lower levels of anticoagulation, while those consulting for hemorrhagic strokes spent a significant higher proportion of their time with an INR out of the ther-apeutic range. Local anticoagulation management in clinical practice should be periodically revised and optimized. 383 Heart and brain Measurement of cerebral blood flow using colour duplex sonography in patients with cardio-embolic stroke: normal values and associated variables D. Carrera1, L. Dinia2, S. Figueroa3, I. Zubizarreta4, E. Martínez-Lizana5, R. Delgado-Mederos6, I. Díaz-Maroto7, O. Ayo-Martín8, T.. Segura9, J. Martí-Fàbregas10 Stroke Unit. Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN1, Stroke Unit. Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN2, Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN3, De-partment of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN4, Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN5, Stroke Unit. Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN6, Department of Neurology. Complejo Hospitalario Universitario de Albacete., Albacete, SPAIN7, Department of Neurology. Complejo Hospitalario Universitario de Albacete., Albacete, SPAIN8, Department of Neurology. Complejo Hospitalario Universitario de Albacete., Albacete, SPAIN9,Stroke Unit. Department of Neurology. Hospital de la Santa Creu i Sant Pau., Barcelona, SPAIN10 Background Global cerebral blood flow (gCBF) can be assessed by ultrasonography, but this non-invasive meth-od has rarely been used for clinical applications. Our aim was to measure gCBF in patients with cardioembolic stroke, evaluating its associations with demographic, clinical and echocardiographic variables. Methods We performed a colour duplex sonography to consecutive patients with cardioembolic stroke, ex-cluding those patients with extracranial carotid or vertebral stenosis >50%. gCBF was obtained as the sum of the blood flow in both internal carotid and vertebral arteries. The blood flow of each artery was calculated from the time-averaged velocity and the cross-sectional area of the vessel. Time-averaged velocities were measured over a minimum of four cardiac cycles. gCBF measure-ment was obtained 3 times, and the final value was the mean of the 3 values. The gCBF value was divided by 1300 (average brain weight) to express the values as ml/100g/min. In a sample of pa-tients, we evaluated the reproducibility of the results by comparing the gCBF obtained by two neu-rologists. We recorded a set of demographic, clinical and echocardiographic variables. Results We studied 78 patients (38.5% men, mean age 77.2 +/- 8.7 years). Mean gCBF was 66.7 +/- 15.4 ml/100g/min. There was no association between gCBF and age or gender. Patients with congestive heart failure had lower gCBF than those without (58.1 +/- 15 ml/100g/min vs 68.9 +/- 14 ml/100g/ min, p = 0.01). There was a correlation between gCBF and left-ventricular ejection fraction (r = 0.27, p = 0.03). In the sample of patients studied by two neurologists (n = 9), there was a good cor-relation between them (r = 0.7, p = 0.05). Conclusion Colour duplex sonography is a simple, reliable and reproducible method for quantifying gCBF. gCBF values are related to cardiac function.
Karger_ESC London_2013
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