22. European Stroke Conference 779 Stroke prevention Accidental points beyond optimal warfarin-therapeutic-range and hemorrhagic complication in post-stroke aged patients T. Ohtsuki1, M. Matsumoto2 Stroke Centre, University of Kinki, Osaka-Sayama, JAPAN1, Hiroshima University Hospital, Hi-roshima, 758 © 2013 S. Karger AG, Basel Scientific Programme JAPAN2 Objective: Japanese Stroke Society’s Guideline for the Management of Stroke 2009 recommends that blood PT-INR should be controlled by warfarin either within 2.0-3.0 if stroke patient’s age is under 69 or within 1.6-2.6 if over 70, to keep a balance between secondary prevention of cardiogen-ic embolism by atrial fibrillation and accidental hemorrhagic complications. We examined if hemor-rhagic complication, nevertheless, took place more frequently among aged Japanese patients. Methods: The 38 patients who had recent episodes of embolic infarction/TIA due to non-valvular atrial fibrillation were prospectively observed for 12 months, when the prescription and doses of warfarin were modified by monthly measured PT-INR. Points (0-12) beyond optimal TR from the consecutive monthly measurement were noted, and hemorrhagic events were confirmed by the med-ical records. We divided the patients into the 2 groups by age: the group of the younger 19 patients, aged 34-69, median 59, male 10 and the older group of 19 patients; aged 70-90, median78, male10. Results: Average blood pressures for the younger and the older groups were 115±14/70±10 and 122±20/70±10 mmHg, the averages of 12 PT-INRs were 2.33±0.74 and 2.17±1.10, points beyond optimal TR were 1.7±1.6 and 2.4±3.7, respectively (no statistical differences). As for a total number of 12 hemorrhagic events, 3 minor mucosal hemorrhages were reported from the Youngers, whose 3 points consisted of 2 beyond TR and 1 within TR. In contrast, a total of 9 events happened in the older 8 patients (minor 5 bleedings, 2 intracranial and 2 major gastrointestinal bleedings), when 7 INRs showed within/below the optimal TR and 2 did beyond TR. Conclusion: The more warfarin-associated hemorrhagic complications were observed in the older post-stroke patients than 70 years old, however, that failed to correlate with average blood pressure and PT-INR beyond optimal therapeutic range. Aging may jeopardized warfarin-treated stroke pa-tients in hemorrhage. 780 Stroke prevention Dabigatran for secondary stroke prevention in clinical practice: a cohort of 84 patients. A. DeFelipe Mimbrera1, M.C. Matute2, A. Alonso-Cánovas3, M. Guillán4, I. Hernández-Medrano5, S. Sainz de la Maza6, J. Masjuan7 Hospital Ramon y Cajal, Madrid, SPAIN1, Hospital Ramon y Cajal, Madrid, SPAIN2, Hospi-tal Ramon y Cajal, Madrid, SPAIN3, Hospital Ramon y Cajal, Madrid, SPAIN4, Hospital Ramon y Cajal, Madrid, SPAIN5, Hospital Ramon y Cajal, Madrid, SPAIN6, Hospital Ramon y Cajal, Madrid, SPAIN7 Background: Dabigatran has been recently approved for stroke prevention in nonvalvular atrial fibrillation. Most data regarding efficacy and safety is driven from clinical trials; information from clinical practice is lacking. Methods: We prospectively included patients starting dabigatran for secondary stroke prevention at our hospital from March 2010 to October 2012. Clinical, efficacy, and safety variables were regis-tered. Results: Eighty-four patients were included with a mean follow-up of 11 months (range 1-21). For-ty- four were male (50%), mean age 76.3 (range 50-95, SD 20.8), median CHADS2 4 (range 2-6), CHA2DS2-VASc 5 (range 2-9), and HAS-BLED 2 (range 1-5). Indication for dabigatran was isch-emic stroke in 80 patients (59.5% anticoagulation naïve and 35.7% previously on warfarin) and acute intracerebral hemorrhage (IH) due to warfarin in 4 (4.8%). Dabigatran 110 mg bid was pre-scribed in 55 cases (65.5%), and 150 mg bid in the remaining. Six patients received concomitant an-tiaggregation due to vascular disease. Twelve patients (14.3%) suffered 15 events during follow-up. Ischemic events (8) consisted in 4 transient ischemic attacks (TIA), 3 ischemic strokes (1 of them disabling) and one acute coronary syndrome. Three TIAs and all ischemic strokes occurred during the first month of treatment. Hemorrhagic events (7) lead to dabigatran discontinuation in 3 patients, and were IH (1, not disabling), lower gastrointestinal bleeding (5, 3 requiring blood transfusion), and mild metrorrhagia (1). All patients with history of IH remained uneventful. Two patients died (pneumonia and congestive heart failure) and 8 were lost during follow-up. Conclusions: In our cohort most ischemic events were non-disabling and occurred during the first month of treatment, which might be regarded as a high risk period. IH was infrequent and non-dis-abling. Dabigatran was safe and efficacious in secondary stroke prevention in an unselected cohort of old patients with high CHADS2 score.
Karger_ESC London_2013
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