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22. European Stroke Conference 751 Stroke prevention The Impact of Asymptomatic Middle Cerebral Artery Stenosis on Cardiovascular Events among Type 2 Diabetic Patients---A Long-term Follow-up J.G. Duan1, X.Y. Chen2, A. Lau3, A. Wong4, G.N. Thomas5, B. Tomlinson6, R. Liu7, J.C.N. Chan8, T.W. Leung9, V Mok10, K.S. Wong11 Medicine and Therapeutics, Prince of Wales, Chinese University of Hong Kong, Hong KONG SAR, HONG-KONG1, Medicine and Therapeutics, Prince of Wales, Chinese University of Hong Kong, Hong Kong, SAR, HONG-KONG2, Medicine and Therapeutics, Prince of Wales, Chinese University of Hong Kong, Hong Kong, SAR, HONG-KONG3, Department of Psychological Stud-ies, Hong Kong Institute of Education, Hong Kong, SAR, HONG-KONG4, Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UNITED KING-DOM5, Medicine and Therapeutics, Prince of Wales, Chinese University of Hong Kong, Hong Kong, SAR, HONG-KONG6, Medicine and Therapeutics, Prince of Wales, Chinese University of Hong Kong, Hong Kong, SAR, HONG-KONG7, Medicine and Therapeutics, Prince of Wales, Chi-nese University of Hong Kong, Hong Kong,SAR, HONG-KONG8, Medicine and Therapeutics, Prince of Wales, Chinese University of Hong Kong, Hong Kong,SAR, HONG-KONG9, Medicine and Therapeutics, Prince of Wales, Chinese University of Hong Kong, Hong Kong,SAR, HONG-KONG10, Medicine and Therapeutics, Prince of Wales, Chinese University of Hong Kong, Hong Kong,SAR, HONG-KONG115 Background: In Chinese type 2 diabetic populations, asymptomatic middle cerebral artery stenosis (MCA+) has been showed to be associated with vascular mortality, but has not yet to be reported for cardiovascular events. We aimed to explore the effect of asymptomatic MCA+ on cardiovascular events including ischemic stroke and acute coronary syndrome in Chinese type 2 diabetic patients. Methods: This is a prospective and consecutive cohort study. 2171 Chinese type 2 diabetic patients without symptoms of cerebral vascular disease were recruited from the diabetes clinic between 1994 and 1996. Follow-up period was from 1994-Aug 2012. We assessed the occurrence of cardiovas-cular events by Kaplan-Meier analysis. Cox regression was used to determine if the asymptomatic MCA+ was associated with ischemic stroke and ACS. Some terms of diagnostic testing were used to assess the predictive values of asymptomatic MCA+ for CVD. Results: MCA+ was detected by TCD in 264 (12.31%) patients at baseline. Follow-up was complet-ed in 2144 patients. After a mean follow-up of 13.1±3.96 years, 603 patients died. Stroke occurred in 64 (24.24%) patients with and 289 (15.37%) patients without MCA+ (p<0.001). 82 (31.06%) patients with and 373 (19.84%) patients without MCA+ had ACS (p<0.001). 28 (10.61%) patients with and 98 (5.21%) patients without MCA+ developed stroke and ACS both (p<0.001). The cumu-lative occurrences of stroke, ACS or stroke and ACS were higher in diabetic patients with MCA+ than those without during 19-year follow-up. After adjustment for covariates, MCA+ was an inde-pendent predictor for ischemic stroke, ACS, or stroke and ACS both in type 2 diabetic patients, with positive likelihood ratios greater than 1, negative likelihood ratios less than 1, relatively high speci-ficity and negative predictive values. Conclusion: Detection of asymptomatic MCA stenosis by TCD can be used to identify type 2 dia-betic patients at risk of future ischemic stroke and ACS. 742 © 2013 S. Karger AG, Basel Scientific Programme 752 Stroke prevention Outcomes of early anticoagulation following ischemic stroke or transient ischemic attack in the setting of atrial fibrillation D.B. Smith1, G. Stotts2, A. Beliavsky3, D. Dowlatshahi4 University of Ottawa, Ottawa, CANADA1, University of Ottawa, Ottawa Hospital Research Insti-tute, Ottawa, CANADA2, University of Ottawa, Ottawa, CANADA3, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, CANADA4 Introduction The benefit of oral anticoagulants for stroke prevention in patients with atrial fibrillation (AF) is well established, but the safety of early anticoagulation following acute stroke/TIA in patients with AF is unclear. Our objective was to explore the relationship between early anticoagulation for AF following ischemic stroke/TIA and symptomatic hemorrhage and stroke recurrence in a large aca-demic hospital. Methods We performed a chart review of adult patients with stroke/TIA and known or newly diagnosed AF admitted to our hospital in 2010 and 2011. We recorded the use of anticoagulant treatment within 48 hours of stroke/TIA and the rates of recurrent stroke or symptomatic hemorrhage. This project was approved by the institutional ethics board. Results Of 189 patients admitted for stroke/TIA with AF, 49% (93/189) had anticoagulants started within 48 hours: 25% (48/189) received parenteral anticoagulants, 40% (76/189) received warfarin, and 3.7% (7/189) received dabigatran. The 7–day symptomatic hemorrhage rate was 8.5% overall (see table 1). In anticoagulated patients, all hemorrhages were extra-cranial: 12% (6/48) for parenteral anti-coagulation, 5.3% (4/76) for warfarin, and none with dabigatran. In the non-anticoagulated group, hemorrhage occurred in 10% (10/96), 7 of which were within 24 hours of tPA, and 5 of which were intracranial. The 7-day recurrent stroke/TIA rate was 4.8% overall: 4.2% (4/96) in the non-antico-agulated group compared to 2.1% (1/48) with parenteral anticoagulation (p=0.66), 2.6% (2/76) with warfarin (p=0.69), and 14% (1/7) with dabigatran (p=0.30). Conclusion Early anticoagulation after stroke/TIA with AF was common in our institution and associated with extracranial, rather than intracranial hemorrhage. Recurrent strokes were rare and not statistically different across groups.


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