London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 751 767 Stroke prevention Reasons patients with known atrial fibrillation were not on anticoagulation prior to stroke. L.V. Mabanta1, D. Labovitz2 Montefiore Medical Center, Bronx, USA1, Montefiore Medical Center, Bronx, USA2 Background AF increases the incidence of stroke 5-fold and AC reduces that risk by 68%. The chads2vasc score stratifies stroke risk and guidelines support AC for a score >=2. However, many patients with AF are not treated with AC. This study describes the reasons given for not treating patients with known atrial fibrillation (AF) with oral anticoagulation (AC) who were later admitted to Montefiore Medi-cal Center with ischemic stroke (IS). Design/Methods We used the Montefiore Stroke Registry to identify patients with previously known AF not on oral AC who were admitted with acute IS or TIA, January 2010 through December 2011. Chart review was conducted to identify the reason to withhold AC. Results Among 258 patients with confirmed IS and TIA known to have AF prior to admission, 252 (98%) had a chads2vasc score >=2, indicating a risk of stroke high enough to justify AC. Among this group, 125 (50%) were not on AC. The leading reason (31%) for withholding AC was history of bleeding: GI bleed 17 cases (14%), traumatic or spontaneous intracranial hemorrhage 14 (11%) and other bleed 8 (6%). Fall risk was recorded in 29 (23%), nonadherence or refusal 20 (16%), and no identifiable reason 18 (14%). Of the remaining 23 cases, 21 had a variety of other reasons explicitly identified such as age or paroxysmal AF that were not clearly contraindications. Stroke resulted in death in 12 (10%) and nursing home placement in 50 (40%). 59 (52%) of surviving patients were discharged with plans for AC treatment. Conclusions Almost all patients with AF admitted with stroke had a risk of stroke high enough to justify AC, but only half were treated. Some had excessive bleeding risk, refused or were nonadherent but more than half had no or relatively minor contraindications. The consequences were possibly avoidable but severe: half of these patients were discharged to a nursing home or died. 768 Stroke prevention Effective detection of Paroxysmal Atrial Fibrillation in Cerebral Ischaemia using Prolonged Ambulatory ECG monitoring A. ALI1, J. RUSSELL2, M. WALTER3, K. EJAZ4, S. AHMED5 DIANA PRINCESS OF WALES HOSPITAL, GRIMSBY, UNITED KINGDOM1, DIANA PRINCESS OF WALES HOSPITAL, GRIMSBY, UNITED KINGDOM2, DIANA PRINCESS OF WALES HOSPITAL, GRIMSBY, UNITED KINGDOM3, DIANA PRINCESS OF WALES HOSPI-TAL, GRIMSBY, UNITED KINGDOM4, DIANA PRINCESS OF WALES HOSPITAL, GRIMSBY, UNITED KINGDOM5 Background Atrial fibrillation (AF) is an important risk factor for ischaemic stroke, implicated in 20% cases and associated with increased stroke mortality and disability. Diagnosing AF changes stroke prophylax-is therapy, from antiplatelet to oral anticoagulation, lowering risk of stroke recurrence and severity. Paroxysmal AF (PAF) is as great a risk for stroke as permanent AF. PAF detection yield on 24 hour Holter monitoring varies from 1-8%, studies have shown increased detection rates from extended monitoring. We do prolonged monitoring in our stroke/TIA patients when significant risk factors are not demon-strated and no underlying cause had been identified after the investigations. These investigations in-cluded carotid Doppler scans, ECG, and thrombophilia screening and transoesophageal echo where indicated. This study was conducted to evaluate the detection of AF in our patient group using prolonged mon-itoring. Methods First sixty patients who had presented to the stroke service of Diana Princess of Wales Hospital and underwent prolonged monitoring with SpiderFlash equipment. Retrospective notes review was carried out, proforma used for data collection. 51 patients had diag-nosis of stroke or TIA, with no underlying cause identified after investigation. An alternative diag-nosis was subsequently made in 9 patients. Monitoring duration varied from 7 to 21 days. Results Seventeen cases of PAF were identified from 60 patients (28%) presented to stroke serivce. Diagnosis of stroke/TIA confirmed in 51 patients and PAF was detected in 15 cases (29%). Three patients had diagnosis of syncope, PAF was found in two and one had sick sinus syndrome. None of the remaining 6 patients had any abnormality on prolonged ambulatory ECG monitoring. Other abnormalities requiring cardiology referral were present in 10/60 patients. No PAF was de-tected with ambulatory monitoring less than 10 days Conclusion A higher than previously reported PAF yield was detected in this study. Ambulatory ECG monitor-ing (>/= 10 days) should be considered for all patients presenting with cryptogenic stroke/TIA.
Karger_ESC London_2013
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