London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 497 398 Heart and brain Pre admission and on discharge Antithrombotic treatment profile in stroke patients with atri-al fibrillation in a Singapore tertiary hospital A.P. RAMASWAMI1, E Ang2, S S Ho3, F P Woon4, S C Ng5, H M Chang6, D A De Silva7 SINGAPORE GENERAL HOSPITAL, SINGAPORE, SINGAPORE1, NATIONAL NEURO-SCIENCE INSTITUTE, SINGAPORE, SINGAPORE2, NATIONAL NEUROSCIENCE INSTI-TUTE, Singapore, SINGAPORE3, SINGAPORE GENERAL HOSPITAL, singapore, SINGA-PORE4, Sinagpore Genral Hospital, singapore, SINGAPORE5, NATIONAL NEUROSCIENCE INSTITUTE, Singapore, SINGAPORE6, NATIONAL NEUROSCIENCE INSTITUTE, SINGA-PORE, SINGAPORE7 Background: Atrial fibrillation (AF) increases ischemic stroke risk by 5- fold, which is proven to be reduced with anticoagulation in patients with CHA2D2VASC score>1. We studied the pre-ad-mission and on-discharge antithrombotic treatment profile of AF patients presenting with ischemic stroke to a Singapore tertiary hospital. We also investigated the association of CHA2D2VASC score with the debilitating stroke subtype total anterior circulation infarct (TACI). Method: We studied consecutive ischemic stroke patients with known or newly diagnosed AF presenting to the Singa-pore General Hospital from January to November 2012. CHA2D2VASC score and antithrombotic medication pre-admission and post-discharge were noted. Result: Among the 60 ischemic stroke patients studied, 47 had known AF (all with CHA2D2VASC score>1) and 13 had AF diagnosed during the hospital admission. Only 21% (10/47) of known AF patients were on anticoagulation on admission, with only 30% (3/10) having a therapeutic INR of 2-3. A higher proportion of known AF patients with a CHA2D2VASC score>5 had TACI (46%) compared to those with CHA2D2VASC score≤5 (8%) (p=0.008). At the time of discharge, 51% of patients with known or newly diagnosed AF were on oral anticoagulants (40% warfarin, 11% new oral agents), 39% were on antiplatelets and 10% were not on any antithrombotic medication. Of the 37 patients with known AF and not on anticoagulation pre-admission, 16 (43%) were prescribed anticoagulation on discharge (12 warfarin, 4 new oral agents). Conclusion: Most patients with known AF presenting with ischemic stroke were not on the appropriate anticoagulation. High CHA2D2VASC score>5 was associated with TACI which carries a very poor prognosis. The finding that 43% of known AF patients not on anticoagu-lation pre-admission were discharged with anticoagulants indicates no absolute contraindication for this proven treatment and suggests missed opportunities for primary stroke prevention in AF in Sin-gapore. 399 Heart and brain Ultrasonographic features of carotid arteries and risk factors for stroke in patients prior to open heart surgery M.M. MENIH1 UNIVERSITY CLINICAL CENTRE, MARIBOR, SLOVENIA1 Background. The aim of the study was to determine: 1. the prevalence of carotid artery disease in patients undergoing coronary artery bypass grafting (CABG) and valve replacement (VR); 2. the as-sociation of risk factors with the severity of carotid and coronary artery disease; 3. the association of carotid bruit with carotid artery disease; 4. the risk of postoperative complications. Patients and methods. Ninety-three patients undergoing CABG and VR were included in the study. We performed ultrasound (US) of carotid arteries. According to the degree of internal carotid artery (ICA) stenosis, patients were divided into four groups: I. normal ICA and ICA stenosis < 30%; II. ICA stenosis 30 – 50%; III. ICA stenosis 50 – 70%, IV. ICA stenosis > 70%. All patients were ex-amined for the presence of carotid bruit. Results. The prevalence of ICA stenosis over 50% (groups III, IV) occurred in 16,1% of patients, ICA stenosis over 70% (group IV) occurred in 6,4%. Accord-ing to risk factors we found statistical significance in correlation between ICA stenosis over 50% (p < 0,0001), and between ICA stenosis over 70% (p < 0,002) with peripheral artery occlusive disease. We did not find any statistical significance in correlation for carotid bruit with carotid artery steno-sis, we found statistical significance in correlation for carotid bruit and valve pathology. Fifty-five patients underwent CABG, 18 patients underwent both VR and CABG, and 20 patients underwent only VR. ICA stenosis over 50% was found in the CABG group in 9 patients, in the CABG and VR group in 4 patients and in the VR group in 2 patients. Postoperative complications were rare. Conclusions. The prevalence of carotid artery disease in patients undergoing CABG and/or VR was low. Carotid bruit had low predictive value for ICA stenosis. We had low frequency of postoperative complications.
Karger_ESC London_2013
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