London, United Kingdom 2013 Behavioral disorders and post-stroke dementia (PO 403 - 439) Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 499 402 Heart and brain Dabigatran etexilate for secondary stroke prevention: the first year experience from a multi-center implementation study G. Tsivgoulis1, K.A. Sands2, C. Krogias3, V.K. Sharma4, K. Vadikolias5, I. Heliopoulos6, H. Shiue7, M. Flamouridou8, A, Mitsoglou9, S. Tsakaldimi10, P. Dalos11, K. Charalampopoulos12, S. Boutzoni13, D. Athanasiadis14, C. Piperidou15 Department of Neurology, Democritus University of Thrace,, Alexandroupolis, GREECE1, Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham,, Birmingham, AL, USA2, Department of Neurology, St. Josef-Hospital, Ruhr University,, Bochum, GERMANY3, Division of Neurology, Department of Medicine, National University Hospital,, Singapore, SINGAPORE4, Department of Neurology, Democritus University of Thrace, Alexan-droupolis, GREECE5, Department of Neurology, Democritus University of Thrace, Alexandroupo-lis, GREECE6, Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham,, Birmingham, AL, USA7, Department of Neurology, Democritus University of Thrace, Alexandroupolis, GREECE8, Department of Neurology, Democritus University of Thrace, Alexan-droupolis, GREECE9, Department of Neurology, Democritus University of Thrace, Alexandroupolis, GREECE10, De-partment of Neurology, Democritus University of Thrace, Alexandroupolis, GREECE11, Depart-ment of Neurology, Democritus University of Thrace, Alexandroupolis, GREECE12, Department of Neurology, Democritus University of Thrace, Alexandroupolis, GREECE13, Vascular Unit, Third Department of Surgery, School of Medicine, University of Athens, School of Medicine,, Ath-ens, GREECE14, Department of Neurology, Democritus University of Thrace, Alexandroupolis, GREECE15 Background&Purpose: Dabigatran etexilate (Dabigatran) is a novel oral thrombin inhibitor approved for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). There are growing concerns for side effects. We sought to prospectively evaluate the safety, efficacy and adherence to dabigatran for secondary stroke prevention in a multi-center implementa-tion study. Subjects&Methods: Consecutive AF patients with ischemic stroke (IS) or Transient Ischemic Attack (TIA) were treated with dabigatran for secondary stroke prevention according to AHA recommenda-tions at four tertiary care stroke centers. The study population was prospectively followed and out-comes (IS, TIA, systemic embolism, pulmonary embolism, myocardial infarction) were documented according to RELY methodology. The primary safety outcome was major hemorrhage defined ac-cording to RELY criteria. Secondary safety outcomes included all other bleeding events that were classified as minor bleedings. Results: A total of 78 AF patients (mean age 71±9years; 54% men; 81% IS and 19% TIA; median CHADS2 score 4; range 2-5) were treated with dabigatran (110mg bid (74%) or 150mg bid (26%). During a mean follow-up period of 5±4 months we documented no cases of IS, TIA, intracranial hemorrhage, systemic embolism or myocardial infarction in AF patients treated with dabigatran. There was 1 case of pulmonary embolism (1.3%), 1 (1.3%) major bleed (gastro-intestinal bleed) and 2 (2.6%) minor bleeds (1 case of hematuria and 1 case of rectal bleeding). Dabigatran was discontin-ued in 26% of the study population with high cost being the most common reason for discontinua-tion (50%). In 2 cases (10% of patients who discontinued dabigatran) an embolic event (1 case of IS and 1 case of systemic embolism) occurred when coumadin was substituted for dabigatran. Conclusions: Our pilot data indicate that dabigatran appears to be safe for secondary stroke preven-tion during the first year of implementation of this therapy, although high cost may limit the long-term treatment of AF patients leading to early discontinuation of dabigatran in a quarter of our pa-tients. 403 Behavioral disorders and post-stroke dementia Poststroke dementia is associated with recurrent ischaemic stroke G. Sibolt1, S. Curtze2, S. Melkas3, J. Putaala4, T. Pohjasvaara5, M. Kaste6, P. Karhunen7, N.K.J. Oksala8, T. Erkinjuntti9 Department of Neurology, Helsinki University Central Hospital and Department of Neurolog-ical Sciences, University of Helsinki, Helsinki, FINLAND1, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Hel-sinki, FINLAND2, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, FINLAND3, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Hel-sinki, Helsinki, FINLAND4, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, FINLAND5, Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, Univer-sity of Helsinki, Helsinki, FINLAND6, School of Medicine, Forensic Medicine, University of Tam-pere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, FINLAND7, Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, FIN-LAND8, Department of Neurology, Helsinki University Central Hospital and Department of Neuro-logical Sciences, University of Helsinki, Helsinki, FINLAND9 Background: The objective of this study was to investigate whether poststroke dementia diagnosed after ischaemic stroke predicts recurrent ischaemic stroke in long-term follow-up. Methods: We included 486 consecutive patients with ischaemic stroke admitted to Helsinki Univer-sity Central Hospital who were followed up for 12 years. 388 had their first-ever stroke. Dementia was diagnosed in 115 patients using the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) criteria. Kaplan-Meier log-rank analyses was used to estimate the effects of risk factors and poststroke dementia on survival free of recurrent stroke. The hazard ratios for stroke re-currence were calculated using Cox proportional hazards models. Results: Patients with poststroke dementia had a shorter mean time to recurrent stroke (7.13 years, 95% CI 6.20-8.06) than patients without dementia (9.41 years, 8.89-9.92; log rank p<0.001) in the entire cohort. This finding was replicated in patients with first-ever stroke (6.89 years, 5.85-7.93 vs. 9.68 years, 9.12-10.24; p<0.001). Poststroke dementia was associated with increased risk for recurrent stroke both in the entire cohort (hazard ratio 2.02; 95% CI 1.47-2.77) and in those with first-ever stroke (2.40; 1.68-3.42) in Cox univariate analysis. Poststroke dementia was associated with increased risk for recurrent stroke both in the entire cohort (1.84; 1.34-2.54) and in those with first-ever stroke (2.16; 1.51-3.10) after adjustment for the significant covariates of age, atrial fibrilla-tion, peripheral arterial disease, and hypertension. Conclusions: Poststroke dementia is associated with the recurrence of ischaemic stroke in long-term follow-up and should be considered when estimating prognosis.
Karger_ESC London_2013
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