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22. European Stroke Conference 773 Stroke prevention Management of newly diagnosed Atrial Fibrillation in Acute Stroke at North Bristol NHS Trust, United Kingdom M. KAPOOR1, N. BALDWIN25 NORTH BRISTOL HOSPITALS NHS TRUST, BRISTOL, UNITED KINGDOM1, NORTH BRISTOL HOSPITALS NHS TRUST, BRISTOL, UNITED KINGDOM2 Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a potent predic-tor of first as well as recurrent stroke. Optimum thromboprophylaxis is of paramount importance in these patients particularly following a stroke event, as a form of secondary prevention. It is therefore necessary to evaluate whether oral anticoagulation was initiated appropriately in this group. Method: A retrospective case note review of patients admitted in North Bristol NHS Trust, with pri-mary diagnosis of ischaemic stroke and newly recognised AF between May 2012 and October 2012. The data was collected on demographics, repeat brain imaging 14 days following stroke, initiation of anticoagulation post stroke and 90-day outcome. The standards were measured against the best practice guidelines from NICE, SIGN and the European Society of Cardiology. Results: We identified 52 patients which represented 23.9% of all stroke admissions. 47 case notes were analysed as there was insufficient data for remaining five patients. Anticoagulation was started in 80.4% of study population with more than half as inpatient. The rationale for the failure to anti-coagulate was documented in 42.3% of cases, the commonest reason being prior history of gastro-intestinal bleed. Anticoagulation was delayed in 3 patients due to significant hemorrhagic changes on repeat neuroimaging. Majority were started on Dabigatran (64%) followed by Rivaroxaban and Warfarin.38.6% did not have a repeat brain imaging to exclude haemorrhagic transformation, before commencing anticoagulation. Out of 8 eligible subjects who were not anticoagulated, 2 had a further ischaemic stroke within the follow up period. Conclusion: The study showed guidelines were not adhered to particularly with, repeat brain imag-ing and starting anticoagulation appropriately. Review of our local guidelines and more training of healthcare professionals involved in the care of this group of high risk patients is necessary to im-prove 754 © 2013 S. Karger AG, Basel Scientific Programme outcome. 774 Stroke prevention Changed something in prevention of stroke in patients with atrial fibrillation from 2002? Z. Gdovinova1, V. Han2, N. Lesko3, S. Brodnanska4 Department of Neurology, Faculty of Medicine, P.J. Safarik University Kosice and University Hospital L. Pasteur Kosice, Kosice, SLOVAKIA1, Department of Neurology, Faculty of Medicine, P.J. Safarik University Kosice and University Hospital L. Pasteur Kosice, Kosice, SLOVAKIA2, De-partment of Neurology, Faculty of Medicine, P.J. Safarik University Kosice and University Hospital L. Pasteur Kosice, Kosice, SLOVAKIA3, Department of Neurology, Faculty of Medicine, P.J. Safar-ik University Kosice and University Hospital L. Pasteur Kosice, Kosice, SLOVAKIA4 Background: Atrial fibrillation (AF) is a major risk factor for stroke, leading to a fivefold increase in risk. In our study in 2002, only 6% of patients with AF who were admited with stroke at our depart-ment were treated with oral anticoagulant therapy. Methods: 393 patients mean age 74,5 years (224 men -57% and 169 women - 43%) with ischemic stroke hospitalized at the Department of Neurol-ogy between July the 1st, 2011 and June the 30th, 2012 were analysed in the study. Outcome was evaluated by modified Rankin scale (mRS). Results: AF before stroke was present in 74 (18,83%) patients (33 men – 14,73% and 41 women – 24,2%). Oral anticoagulant therapy or LMWH were used before stroke by 18 (24,3%) from these 74 patients. Only in 7 of them INR was ≥ 2,0 (but in two patients it was > 3,5) on admission. In 11 patients INR was < 2,0. It means, that only 5 (6,7%) patients from 74 patients with atrial fibrillation who were admited because of ischemic stroke used anticoagulant therapy and had INR in therapeutic range. Outcome at dischagre was mRS = 3,82 in patients without anticoagulant therapy, mRS = 3,23 in patients with anticoagulant therapy and mRS = 2,8 in patients without AF. When we compare results with 2002, there is very small difference when patients in therapeutic range are evalutaed. Conclusion: In spite of guidelines for prevention of stroke in patients with AF, the number of patients who are treated properly, is still very low, and out-come of stroke in patients with AF is worse than in treated patients or in patients without AF. One of the reasons why anticoagulant therapy is not used, could be the risk of bleeding. New oral anticoag-ulants with lower risk of bleeding can be the possibility how to improve prevention of stroke in pa-tients with atrial fibrillation.


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