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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 741 749 Stroke prevention The Gap between Trial Data and Clinical Practice - Compilation and Analysis of Case Reports on Cerebral Ischemia and Severe Bleeding under Dabigatran and Rivaroxaban W. Pfeilschifter1, C. Foerch2 Goethe University Hospital, Department of Neurology, Frankfurt am Main, GERMANY1, Goethe University Hospital, Department of Neurology, Frankfurt am Main, GERMANY2 Background and Purpose: The novel oral anticoagulants (NOA) dabigatran and rivaroxaban have shown non-inferiority compared to warfarin concerning the prevention of stroke and systemic embo-lism as well as the risk of hemorrhagic complications in large phase III trials for stroke prevention in patients with atrial fibrillation (AF). Whether these results translate into clinical practice is a matter of ongoing research. Methods: To identify risk factors which impair the anticoagulant potency or increase the risk of hemorrhage under NOA, we performed a PubMed search for each dabigatran and rivaroxaban AND three search terms to detect each cerebral ischemia and hemorrhagic complications. We analyzed the case reports of cerebral ischemia for medication adherence issues and the cases of hemorrhagic complications for prescriber errors, unfavorable comedications, renal impairment and prescription of NOA in the frail elderly. Results: We found a discrepancy in the frequency of case reports concerning both cerebral ischemia and hemorrhagic complications to the disadvantage of dabigatran. As risk factors, we identified medication adherence issues, prescriber errors, impaired renal function, comedication with antiplate-let drugs or p-glycoprotein inhibitors, old age and low body weight. Interestingly, the majority of the events reported in this compilation of case reports showed at least one (80 %) and in most cases several risk factors. Every fifth case on hemorrhagic complications reported prescription of warfarin in frail elderly patients (< 80 y and/or < 40 kg body weight) with impaired renal function, often with hazardous comedication. There were only 4 out of 28 reports on hemorrhagic complications that oc-curred in the absence of a risk factor of anticoagulant-associated hemorrhage. Conclusions: The NOA may have a beneficial risk-to-benefit ratio in comparison with warfarin and most of the reported cases of NOA-associated hemorrhages were precipitated by at least one risk factor. We should therefore carefully select our patients for treatment with the NOA and monitor them faithfully concerning their medication adherence and eventual side effects. 750 Stroke prevention Effects of combination therapy with levamlodipine and bisoprolol on stroke in rats G.Z. Huang1 Department of Gerontology, Sixth People’s Hospital, Shanghai, CHINA1 Background: To test the effects of combination with levamlodipine and bisoprolol on stroke in rats. Methods: For acute study, a single dose of drugs was administrated via an intragastric catheter. Sys-tolic blood pressure (SBP) and heart period (HP) were monitored in conscious rats before and after drug administration. To observe the protection of drugs against ischemic cerebral injury, rats were subjected to middle cerebral arterial occlusion half an hour after drug administration; 24 h later, the infarct size were measured. For long-term treatment study, drugs were delivered via rat chow in stroke prone-spontaneously hypertensive rats (SHR-SP). The survival time of each rat was recorded. Results: SBP was significantly reduced by combination therapy with levamlodipine and bisoprolol both in SHR-SP and SAD rats. Neutralization on heart rate was observed in combination. In SHR-SP, BRS was enhanced in levamlodipine alone and combination. In SAD rats, reduction of SBPV was observed only in combination. In long term treatment study, the lifespan of SHR-SP in com-bination was notably longer than that in other groups. Both in SD rats with and without SAD, the infarct areas were the smallest in combination. Conclusion: The combination of levamlodipine and bisoprolol has a better protection on stroke.


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