22. European Stroke Conference 754 Stroke prevention Utility of a Novel Predicting Bleeding Risk Score (HAS-BLED) to Assess Risk of Bleeding in New Oral Anticoagulation Therapy for Secondary Stroke Prevention T. Kanzawa1, K. Suzuki2, T. Horikoshi3, B. Mihara4 Department of Stroke Medicine,Institute of Brain and Blood Vessels,Mihara Memorial Hospi-tal, Isesaki, JAPAN1, Department of Stroke Medicine,Institute of Brain and Blood Vessels,Mihara Memorial Hospital, Isesaki, JAPAN2, Department of Stroke Medicine,Institute of Brain and Blood Vesse, Isesaki, JAPAN3, Department of Neurology,Institute of Brain and Blood Vessels,Mihara Me-morial Hospital, Isesaki, JAPAN4 Background and purpose: A new oral anticoagulant:dabigatran (DE) has been available for stroke prevention in patients with AF (atrial fibrillation). However, it has been reported that patients includ-ing the elderly and those with renal impairment have a greater risk of severe bleeding and are need-ed to balance the risk of stroke against hemorrhagic events. HAS-BLED score is useful in assessing bleeding risk for anticoagulated patients with warfarin and has not studied in DE. The aim of our study is to evaluate the clinical utility of HAS-BLED score in patients on DE for secondary stroke prevention. Methods: In our single stroke center database from Mar. 2011 to Jan. 2013, 230 consec-utive patients treated with DE were retrospectively studied. A new bleeding risk score termed HAS-BLED (Hypertension>160mmHg, Abnormal renal/liver function, Stroke, Bleeding history or pre-disposition, Labile international normalized ratio, Elderly>65 years, Drugs/alcohol concomitantly) was calculated. In cases of a high risk for bleeding (HAS-BLED>3), patients were treated to lower the HAS-BLED score by lowering blood pressure(BP) and avoiding the abuse of Drugs/alcohol in cooperation with the dietitian, the nurse, and the pharmacist. Results: We included 230 patients who had 65% male, median age:73 (66-80), a mean body weight:59±12, rates of previous TIA/stroke: 82.3%, average CHADS2 score:3.5±0.9, and average CCr:68±28. In 12(4.8%) patients, all of whom are >65 years, DE was discontinued due to CCr<30. The median of HAS-BLED score was 2(1-5). The rate of high bleeding risk (HAS-BLED score>3) was 30.6% at base line and after the inter-vention for a bleeding risk profile significantly decreased to 17.4% (median:2, range:1-4, p<0.05). During follow-up (Median:345 days, IQR:210-532) there was a one patient (0.4%) who suffered a major bleeding event (lower digest tract and not Life-threatening) and 6(2.1%) ischemic stroke or systemic embolism. Conclusion: Our findings suggest the clinical utility of the simple HAS-BLED score not only for predicting the bleeding, but also improving the safety in new oral anticoagulated patients with the management of a risk profile. 744 © 2013 S. Karger AG, Basel Scientific Programme 755 Stroke prevention Developing a psychologically-informed, community based walking intervention for stroke sur-vivors A.J. Wright1, E.A. Walker2, D.P. French3, C. McKevitt4, I. Wellwood5, C.D.A. Wolfe6 King’s College London, London, UNITED KINGDOM1, King’s College London, London, UNITED KINGDOM2, University of Manchester, Manchester, UNITED KINGDOM3, King’s Col-lege London, London, UNITED KINGDOM4, Charité - Universitätsmedizin Berlin, Berlin, GER-MANY5, King’s College London and NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UNITED KINGDOM6 Background: Many stroke survivors who are able to walk do not walk enough to benefit their health and wellbeing. However, walking is an acceptable form of physical activity to older adults that fa-cilitates social participation. We plan to adapt an existing psychologically-informed walking inter-vention for stroke survivors who can walk outdoors. Thus, we aimed to identify the key views about walking for this group and the intervention’s feasibility. Methods: Semi-structured interviews with a purposive sample of 14 South London Stroke Register participants, 3mo-3yr post-stroke, who could walk outdoors. The interview topic guide explored par-ticipants’ beliefs about walking and the acceptability/feasibility of pedometers and action planning. Results: Stroke survivors valued walking’s potential to increase health, fitness, and their ability to travel to desired places, but were worried walking more might increase pain from comorbid condi-tions. Participants’ families were the largest social influence on walking. Increasing walking was easier in good weather, in good health and using walking aids. Less active participants were unsure about pedometers, while more active participants were positive about them, saying they quantified walking and gave an impetus for improvement. However, two more active participants felt pedom-eters were only suitable for the less active or those with recent strokes. Regarding planning, partici-pants felt that plans should be tailored to the person and their local urban environment. Conclusion: Stroke survivors’ perceived benefits of, and social influences upon, walking were sim-ilar to those reported for older adults in general. Planning seemed acceptable to most participants. However, the rationale for use of pedometers should be presented carefully to motivate adherence. Successfully adapting the intervention will also require sensitivity to participants’ local neighbour-hoods and comorbid health issues.
Karger_ESC London_2013
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