22. European Stroke Conference 698 Acute stroke: clinical patterns and practice Screening, assessment and prophylaxis of VTE in the context of acute stroke – a UK Physician survey of current clinical practice A.K. Mistri1, E. Ward2, W. Sunman3, F. Lally4, M. Dennis5, C. Roffe6 University Hospitals of Leicester NHS Trust, Leicester, UNITED KINGDOM1, , Stoke-on- Trent, UNITED KINGDOM2, Nottingham University Hospitals NHS Trust, Nottingham, UNITED KINGDOM3, Keele University, Stoke-on-Trent, UNITED KINGDOM4, University of Edinburgh, Edinburgh, UNITED KINGDOM5, Keele University, Stoke-on-Trent, UNITED KINGDOM6 BACKGROUND Acute stroke is a pro-thrombotic state due to reduced mobility, dehydration and a general pro-in-flammatory state. Dated autopsy studies suggest that pulmonary embolism accounts for 25% of deaths post stroke. However, clinically relevant PE may be rare in current practice (<1%). It is im-portant to establish current clinical practice for DVT (deep venous thrombosis) screening, initial as-sessment and prophylaxis for VTE. METHODS A web-based survey of the British Association of Stroke Physicians (BASP) members was undertak-en in September 2012. Figures are reported as percentage of respondents. RESULTS 128 members participated. 91% reported routine DVT screening, with no clear plan for repeat as-sessment (57% ad hoc/not at all). 59% did calf examination, 1-2 times a week (53%), and 80% con-tinued calf examination until discharge/independent mobility. If DVT was suspected, 65% requested a Doppler, while others were selective (22% requested D-dimers; 11% a Well’s score to ascertain need for Doppler). Most scanned both legs (68%) and the full length of the leg (74%). Only 2.5% repeated a Doppler routinely after a negative initial Doppler. Common prophylactic strategies included: optimal hydration (84%) and early mobilisation (75%). 70% never used stockings. 64% rarely used anticoagulation, while 24% used it in all/most cases. This was started at 1-2 weeks from onset, and discontinued at discharge (64%) or when mobile inde-pendently (52%). The commonest modality was Low-Molecular-Weight Heparin (87%). In the set-ting of intracerebral haemorrhage, 64% never used stockings and 79% rarely used anticoagulation. CONCLUSION This survey reports a significant variation in UK clinical practice with respect to DVT screening, initial assessment and prophylaxis for VTE. In the absence of an evidence-based intervention to reduce VTE, the feasibility of a trial of prophylactic anticoagulation in the setting of acute stroke should be considered. 716 © 2013 S. Karger AG, Basel Scientific Programme 700 Acute stroke: clinical patterns and practice Frequency of New Pulmonary Neoplasms in Consequtive Acute Stroke Patients L. Bentsen1, I. Havsteen2, H. Hansen3, A. Christensen4, C. Ovesen5, A. Abild6, H. Christensen7 Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK1, De-partment of Radiology, Bispebjerg University Hospital, Copenhagen, DENMARK2, Department of Radiology, Bispebjerg University Hospital, Copenhagen, DENMARK3, Department of Radiology, Bispebjerg University Hospital, Copenhagen, DENMARK4, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK5, Department of Radiology, Bispebjerg University Hospital, Copenhagen, DENMARK6, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK7 Background: The incidence of possible malignant pulmonary findings in the background population is app. 0,25 %, however malignancy is known to increase the risk of thrombo-embolic events. The aim of this analysis was to report the frequency of tumor suspect lung opacities on routine acute stroke imaging in a thrombolysis population. Method: Non-contrast CT cerebrum and CT angiography (CTA) from aortic arch to vertex, including the lung apices, was performed on admission in acute stroke patients. Imaging was performed using a 64-sec-tion MDCT with an isovoxel resolution down to 0,6 mm. A senior neuroradiologist, blinded to all clinical data, reviewed all scans and registered tumor sus-pect lung opacities in the pulmonary apices. These were then characterized by a senior thoraxradiol-ogist according to radiological parameters of possible malignancy. All clinical, radiological and his-tological information were gathered from medical charts and this included at least 1 year follow-up period and the decisions reached by the multi–specialty tumor conference. Findings were ultimately classified as: Malignant, presumed malignant, presumed benign or benign. Results: 750 patients with final diagnosis stroke or ICH from June 2009-December 2011 were included. 20 patients had tumor suspect lung opacities on CTA, all were described correctly in the primary report. 6 findings were classified as malignant,4 primary lung cancers and 2 lung metastasis, and 3 as pre-sumed malignant. 9 findings were classified as benign and 2 as presumed benign. The group with malignant disposition corresponds to a prevalence of 1,2 % in an acute stroke popu-lation. Conclusion: In the present study the risk of accidental malignant findings in the lung apices in a stroke popula-tion was app. 5 times higher than in the background population. This finding emphasises the relation between stroke and cancer but does not support full CT of the thorax on patients diagnosed with stroke as routine or other screening measures.
Karger_ESC London_2013
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