London, United Kingdom 2013 23 Intracerebral/subarachnoid haemorrhage and venous diseases PRospective Evaluation for the REstart or STop Antithrombotics Randomised Trial (PRE-RE-START) E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 593 M. Pasquini1, C.J.J. van Asch2, N. Samarasekera3, C. Cordonnier4, C.J.M. Klijn5, R. Al-Shahi Sal-man6 (1) EA 1046, Univ Lille Nord de France, Department of Neurology, (2) Université Catholique de Lille, Department of Neurology,, Lille, FRANCE1, (3) Department of Neurology and Neuro-surgery, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, THE NETH-ERLANDS2, (4) Division of Clinical Neurosciences, School of Clinical Sciences, University of Ed-inburgh, Edinburgh, UNITED KINGDOM3, (1) EA 1046, Univ Lille Nord de France, Department of Neurology,, Lille, FRANCE4, (3) Department of Neurology and Neurosurgery, Rudolf Magnus Insti-tute of Neuroscience, University Medical Center, Utrecht, THE NETHERLANDS5, (4) Division of Clinical Neurosciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UNITED KINGDOM6 Background: The proportion of patients taking antithrombotic drugs at the time of spontaneous in-tracerebral haemorrhage (ICH) seems to be increasing over time, but whether to restart these drugs after ICH is unknown. Objective: To compare the proportions of patients who took antithrombotic drugs when admitted with ICH and when discharged in three European countries. Methods: We compared the proportions and characteristics of patients taking antithrombotic drugs in two hospital-based cohorts (Lille, France, n=542; Utrecht, The Netherlands, n=390) and one com-munity- based study (Lothian, Scotland, n=137). Results: Overall, at the time of ICH 298 (28%) patients took antiplatelet agents (APA), 155 (14%) took vitamin K antagonists (VKA) and 25 (2%) took both APA and VKA. Patients taking antithrom-botic drugs were significantly older (median age 77 IQR 15 vs 64 IQR 24 years; p<0.001) and were more likely to be hypertensive (78% vs 47%; p<0.001). The anatomical distribution of ICH differed among the two groups (p<0.05) with a slight increase of cerebellar ICH in patients with an-tithrombotic drugs (13% vs 8%; p=0.004). The proportion of patients taking antithrombotic drugs was similar in the three countries (Lille 43%, Lothian 46%, Utrecht 46%; p=0.74), but the propor-tion of patients taking VKA differed (Lille 12%, Utrecht 19%, Lothian 11%; p=0.01). Among the patients who survived and had a pre-ICH indication for antithrombotic drugs, the proportions re-starting antithrombotic drugs differed between the three countries (Lille 19%, Utrecht 45%, Lothian 15%; p<0.001). Conclusion: Almost half of patients had been taking antithrombotic drugs until their ICH, but the proportion of survivors who restart these drugs differs between three European countries. This vari-ation suggests clinical equipoise about what to do in this situation, which will be addressed in the REstart or STop Antithrombotics Randomised Trial (www.RESTARTtrial.org). 22 Intracerebral/subarachnoid haemorrhage and venous diseases Risk of re-admission for recurrent subarachnoid haemorrhage. Results from the OASIS study. J.M. Worthington1, M. Gattellari2, C. Goumas3, M. Jaeger4, B. Jalaludin5 Ingham Institute of Applied Medical Research and South Western Sydney Clinical School, University of New South Wales, Liverpool, AUSTRALIA1, Ingham Institute of Applied Medical Research and University of New South Wales, Liverpool, AUSTRALIA2, Ingham Institute of Ap-plied Medical Research and University of New South Wales, Liverpool, AUSTRALIA3, Ingham In-stitute of Applied Medical Research and University of New South Wales, Liverpool, AUSTRALIA4, Ingham Institute of Applied Medical Research University of New South Wales, Liverpool, AUS-TRALIA5 Background: This study reports rare population-based estimates for re-admission with recurrent SAH in a large population with prolonged follow-up. Methods: We identified patients discharged alive from hospital after a subarachnoid haemorrhage (SAH) from a census of all hospitalisations in New South Wales, Australia, between 2001-2009. Linkage to subsequent hospitalisations identified re-admissions with recurrent SAH. We computed re-admission rates using Cox regression analyses, with deaths treated as a competing risk, adjusting for age, sex, year of admission, Charlson co-morbidities and clustering by hospital. Results: Of 4,348 patients with SAH, 3,019 were discharged alive (69.4%) providing 11,536 per-son- years of follow-up. Surviving patients averaged 54.7 years of age and 58.6% were female. Over one-half (51.5%) had received intensive care and 25.2% were ventilated. One-year after discharge, the adjusted re-admission rate for a recurrent SAH was 1.9% and 2.0% for males and females, re-spectively. By 5 years, the adjusted re-admission rate was 2.9% for both sexes. Patients under 50 years had an adjusted re-admission rate of 2.6% at 5 years, compared with 5.0% for those over 70 years (Sub-Hazard Ratio=1.95, 95% CI=1.19-3.20) and 2.7% for those aged 50-69 (Sub-Hazard Ra-tio= 1.05, 95% CI=0.59-1.84). Arteriovenous malformations (AVMs) were associated with a higher adjusted risk of re-admission for recurrent SAH (4.3% vs 2.6% at 5 years; Sub-Hazard Ratio=1.69, 95% CI=1.02-2.79). Patients who received neurosurgical services had lower adjusted rates of re-ad-mission at 5 years (1.8% vs 3.6%) (Sub-hazard Ratio=0.49, 95% CI=0.30-0.81). Conclusion: The risk of recurrent SAH, estimated by re-admission rates, is low. Despite the com-peting risk of death, older patients are at an increased risk of re-admission for SAH. Patients with-out AVMs and those who received neurosurgical care were less likely to be re-admitted to hospital with SAH.
Karger_ESC London_2013
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