22. European Stroke Conference 388 Heart and brain Pre-admission and on-discharge antithrombotic treatment profile in ischemic stroke patients with atrial 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 NEU-ROSCIENCE INSTITUTE, SINGAPORE, SINGAPORE2, NATIONAL NEUROSCIENCE IN-STITUTE, SINGAPORE, SINGAPORE3, SINGAPORE GENERAL HOSPITAL, SINGAPORE, SINGAPORE4, SINGAPORE GENERAL HOSPITAL, SINGAPORE, SINGAPORE5, NATIONAL NEUROSCIENCE INSTITUTE, SINGAPORE, SINGAPORE6, NATIONAL NEUROSCIENCE INSTITUTE, SINGAPORE, 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). Methods: 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. Results: 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. 492 © 2013 S. Karger AG, Basel Scientific Programme 389 Heart and brain Transthoracic Echocardiography for ethiological diagnostic of ischemic stroke. N. Bravo Quelle1, F. Diaz Otero2, B. Gutiérrez Ruano3, A. Garcia Pastor4, J. Bermejo Thomas5, P. Sobrino Garcia6, P. Vázquez Alén7, Y. Fernández-Bullido8, JA. Villanueva Osorio9, AC Gil Núñez10 Stroke Unit, Hospital Gregorio Marañon, Madrid, SPAIN1, Stroke Unit, Hospital Gregorio Ma-ranon, Madrid, SPAIN2, Stroke Unit, Hospital Gregorio Maranon, Madrid, SPAIN3, Stroke Unit, Hospital Gregorio Maranon, Madrid, SPAIN4, Ecocardiography Laboratory, Hospital Gregorio Ma-ranon, Madrid, SPAIN5, Stroke Unit, Gregorio Maranon, Madrid, SPAIN6, Stroke Unit, Gregorio Maranon, Madrid, SPAIN7, Stroke Unit, Gregorio Maranon, Madrid, SPAIN8, Stroke Unit, Hospital Gregorio Maranon, Madrid, SPAIN9, Stroke Unit, Hospita Gregorio Maranon, Madrid, SPAIN10 Background: On the etiological study of ischemic stroke, the stroke of unknown origin means a high percentage. The main structural cardiac causes implicated in the cardioembolic stroke are the left ventricle dysfunction and the heart valve disease. Transthoracic Echocardiography (TTE) allows to identification of probably cardioembolism as sources of ischemic stroke in patients without previous cardiologic history (PCH). Methods: We analyze 491 patients of 522 with ischemic stroke admitted in a Universitary Hospital during 2011 year which were tested by TTE. We described TTE`s findings, and we compared two groups: one with previous cardiologic history and the other without previous cardiologic history. We considered the patient to have previous cardiologic history, if the patient had had at least one of the following pathologies: Atrial fibrillation, valvulopathies, ischemic heart disease or congestive heart failure Results: 369 patients (76.7%) don`t have PCH. We compared both groups, and we observed signif-icant statistical differences in: Severe left ventricle dysfunction or dilated myocardiopathy (LVEF <35%) (1.4 % without PCH vs 8.2% with PCH, p=0.001), left ventricle`s segmental akinesia (4.3% % without PCH vs 23.1% with PCH) (p<0.001); calcified aortic stenosis (1.6 % without PCH vs 9.0% with PCH, p<0.001), mild-moderate left ventricle dysfunction (LVEF 35-50%) (4.1 % without PCH vs 18 % with PCH) (p<0.001); left ventricle`s segmental hipokinesia (6.8% without PCH vs 24.6 % with PCH, p<0.001); left atrial dilated (30.4% without PCH vs 55.7% with PCH) (p<0.001). Conclusion: Although there is a smaller proportion of pathological findings cardiac in patients with-out PCH, transthoracic echocardiography is an important test diagnostic in ischemic stroke, and should be performed in all patients with ischemic stroke to reduce the rate of patients with stroke of unknown origin.
Karger_ESC London_2013
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