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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 745 756 Stroke prevention A Closed audit loop on patients with Atrial Fibrillation presenting with Acute ischeamic stroke: “Reducing the numbers by raising the awareness across primary and secondary care” I .K. Natarajan1, S. Al- Araji2, C. Wade3, K . Campion4, C. Lambert5, D . Chandra6 University Hospital of North Staffordshire, Stoke on trent, UNITED KINGDOM1, University Hospital of North Staffordshire, Stoke on trent, UNITED KINGDOM2, University Hospital of North Staffordshire, Stoke on trent, UNITED KINGDOM3, University Hosptial of North Staffordshire, Stoke on trent, UNITED KINGDOM4, University Hospital of North Staffordshire, Stoke on trent, UNITED KINGDOM5, University Hospital of North Staffordshire, Stoke on trent, UNITED KING-DOM6 Background: One in five strokes is attributed to atrial fibrillation (AF). AF related strokes are often fatal and as-sociated with severe disability, and the cost of care to the local health economy is huge. An audit loop was completed after identifying that untreated AF( not anticoagulated) presented with Large Total Anterior Circulation Ischaemic (TACI) strokes resulting in high mortality and morbidity. Fol-lowing education and raising awareness and putting training in place there has been a reduction in number of TACI strokes in patients with AF. Method: The audit loop was completed within a year. Data of first 50 consecutive patients were collected be-tween Jan- April 2012 presenting, to our acute stroke unit, with ischemic stroke and ECG confirm-ing AF. The second 50 consecutive patient’s data was collected between Sep – Nov 2012. There was a 4 months gap between the two cycles; During the gap, results of the first cycle were present-ed locally to health care professionals in primary and secondary care at multiple meetings to raise awareness. Then the second cycle data was collected to close the loop. Results: First cycle results showed that 40% (20/50) of patients were not known to have AF prior to admis-sion, of whom 50% (10/20) presenting with TACI strokes. Of the 60% (30/50) known to have AF prior to admission, 30% were on no preventative medication and only 23% were anti-coagulated. Following education, awareness and putting training in place across primary and secondary care we closed the audit loop and our results showed 28% (14/50) were not known to have AF prior to ad-mission, of whom 64% (9/14) presenting with TACI. 8% were on no preventative medication and 28% were anti-coagulated. Those who were anti-coagulated and with sub-therapeutic INR had mi-nor strokes. Conclusion: Raising awareness to identify AF and starting patients on anticoagulation has resulted in a signifi-cant reduction of frequency of strokes with newly identified AF. It also resulted in more AF patients to be on preventative appropriate anticoagulation. 757 Stroke prevention Left atrial appendage occlusion in patients with atrial fibrillation and previous intracranial haemorrhage S. Horstmann1, T. Rizos2, E. Jenetzky3, U. Krumsdorf4, C. Zugck5, N. Geis6, S. Hardt7, W. Hacke8, R. Veltkamp9 University of Heidelberg, Department of Neurology, Heidelberg, GERMANY1, University of Heidelberg, Department of Neurology, Heidelberg, GERMANY2, University of Mainz, Mainz, GERMANY3, University of Heidelberg, Department of Cardiology, Heidelberg, GERMANY4, Uni-versity of Heidelberg, Department of Cardiology, Heidelberg, GERMANY5, University of Heidel-berg, Department of Cardiology, Heidelberg, GERMANY6, University of Heidelberg, Department of Cardiology, Heidelberg, GERMANY7, University of Heidelberg, Department of Neurology, Heidel-berg, GERMANY8, University of Heidelberg, Department of Neurology, Heidelberg, GERMANY9 BACKGROUND: Oral anticoagulation (OAC) is an effective therapy for ischemic stroke in atrial fibrillation (AF) patients. However, in patients with previous intracranial haemorrhage (ICH) the bleeding risk due to OAC is increased. Percutaneous occlusion of the left atrial appendage (LAAO) is an alternative treatment option. It has not been evaluated in ICH patients with AF. We prospec-tively evaluated safety and feasibility of LAAO in patients with previous ICH. METHODS: Between 11/2010 and 11/2012, LAAO was performed in patients with AF and previous ICH (Amplatzer Cradiac Plug device). National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), CHA2DS2Vasc score and HAS-BLED score were assessed for each patient. Treatment after intervention comprised aspirin plus clopidogrel for 3 months followed by a mo-no- therapy of aspirin. Before and 24h after LAAO and 1,6,12 and 24 months after LAAO the clini-cal status and complications (ischemic stroke, bleeding events) were assessed. RESULTS: Overall, 18/21 (85.7%) eligible patients were treated. In 2 patients anatomic conditions of the left atrial appendage (LAA) were not suitable; in 1 patient LAA thrombus was detected. Mean CHA2DS2Vasc score was 4.4+/-1.6 resulting in an estimated annual risk of ischemic stroke ranging from 4.4% to 6.7%. Mean HAS-BLED score was 4.8+/-0.8. Minor complications (2 inguinal hema-tomas and 1 self-limited asystole) were observed in 3/18 patients (16.7%). No major complication (stroke, death, pericardial effusion, device embolism) was present. During follow-up period (mean 11.6 months; IQR 2.5/18) no ischemic or hemorrhagic strokes were observed. CONCLUSIONS: This is the first uncontrolled, prospective study of LAAO targeting patients with AF and preceding ICH. The procedure appeared safe and effective in terms of ischemic stroke pre-vention. A larger randomized trial comparing LAAO to other options including new OAC is neces-sary to improve management of these patients.


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