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C0409 Prevalence of atrial fibrillation in patients presenting with stroke
Abstracts / Thrombosis Research 130 (2012) S100–S202
C0159 β1 blockers, warfarin and rhythm conversion in atrial fibrillation Ruzan Durgaryan Yerevan No 13 Polyclinic - Nerqin Shengavit 9, 32 Building, Armenia Background: Atrial fibrillation(AF) is the most frequently encountered sustained cardiac arrhythmia in clinical practice and a major cause of morbidity and mortality. Effective treatment of AF still remains an unmet medical need. Treatment of AF is based on drug therapy and ablative strategies. Antiarrhythmic drug therapy is limited by a relatively high recurrence rate and proarrhythmic side effects. Conversion to sinus rhythm(SR) with pharmacological intervention is an actual goal for clinicians though unfortunately not always successful. Methods: 19 female patients have been chosen for trial, all they in postmenopausal period, with previous history of arterial hypertension without valve disease as well as with the first paroxysm of atrial fibrillation and haven't gone to sinus rhythm conversion just after paroxysm. They have been divided into 2 groups for pharmacological intervention either for rhythm control or rate control. 10 patients have been involved in Group1 and 9 patients in Group2. These 2 groups have been adjusted by age, BMI, cholesterol, blood pressure (BP), left ventricular systolic function estimated using left ventricular ejection fraction more than 50%, measured by Simpson and Teichholz method, left atrial diameter less than 50 mm. Group1 has been treated by biseprolol (Coronal), losartan (Sentor), hypochlorthiazide, warfarin with the following mean doses 7,5 mg, 100 mg, 12.5 mg, 3.75 mg respectively. Group2 has been treated by metoprolol tartrate(Egiloc), lisinopril(Diraton), hypochlorthiazide, warfarin with the following mean doses 100 mg, 15 mg, 12.5 mg, 3.75 mg respectively. Dose of warfarin has been chosen to keep INR between 2.0–2.5 before and between 1.5-2 after rhythm conversion, there were no thrombs according to data of transesophageal echocardiography. BP was controlled between normal rages. Results: It has been noticed conversion to SR in 8 patients from 10 in Group1 during 3rd- 4th week of treatment, after amiodaron has been added to treatment. Despite to it in Group2 conversion to SR has been noticed only in 2 patients although there was well rate control in other patients. Any thromboembolic comlication has been noticed neither in Group1 nor in Group2. Comment: In abmulatory practice selective β1 blocker biseprolol which has much less proarrhythmic side effects than other antiarrhythmic drugs can be used for conversion to SR in patient with AF combined with losartan and warfarin, after rhythm conversion treatment can be continued added amiodaron to control the rhythm. INR between 2–2.5 range before and 1.5-2 after rhythm conversion is saved by mean of thromboembolic complications. Although another selective β1 blocker metoprolol can be used for successful rate control. doi:10.1016/j.thromres.2012.08.188
C0409 Prevalence of atrial fibrillation in patients presenting with stroke Uchenna Ozo1, Khalil Peroo2, Gemma Fitzpatrick2, Khalil Kawafi2 1 Fairfield General Hospital, Stroke - FGH, Rochdale Road, Bury, UK; 2 FGH, UK Background: Atrial fibrillation (AF) is a major risk factor in the development of thromboembolic stroke. A significant proportion of these patients are not receiving optimum thromboprophylaxis. Risk
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stratification in AF and subsequent anticoaguation was audited against NICE, SIGN and ESC guidance. Aims/Objectives Identify the incidence of new AF in stroke patients Quantify the prevalence of AF in stroke patients Audit documentation of risk stratification Assess whether anti-coagulation was prescribed according to best practice Methods: All patients with a diagnosis of stroke to the Stroke Unit at Fairfield General Hospital during the period ranging from January to June 2011 (both inclusive) were surveyed.Case notes were reviewed retrospectively and data collected using a specifically designed proforma Results: 272 patients were admitted to the Stroke Unit during a six month. 44 patient (16.2%) met the inclusion criteria, 9 (3.3%) of which were of new onset AF. 42 patients (15.4%) had indications for anticoagulation, four of whom were already on warfarin. The rationale for the failure to anticoagulate was documented in 50% of cases, the commonest reasons being risk of falls and intracranial haemorrhage. A small proportion of patients (12.2%) however failed to receive the correct thrombo-prophylaxis, i.e. warfarin. Around one-fifth (18.2%) died following their stroke. Comment: Risk stratification was not consistently and systematically completed for every patient admitted with AF. CHADS scores were not always calculated, and certainly rarely documented. The development of a clinical pathway for Stroke patients in AF, detailing risk assessment, management and onward referral. Educate medical and nursing teams about risk assessments in AF patient. Re-audit in 6 months to ensure clinical pathway is being adhered to. doi:10.1016/j.thromres.2012.08.189
C0150 The features of antiplatelet therapy in inflammation Liudmila Buryachkovskaya1, Alexander Sumarokov2, Irina Uchitel1 1 Russian Cardiology Research Complex, Department of Thrombosis 3rd Cherepkovskaya, 15A, Moscow, Russia; 2Russian Cardiology Research Complex, Department of Atherosclerosis - 3rd Cherepkovskaya, 15A, Moscow, Russia Background: Platelets are important link between inflammation, thrombosis and atherogenesis. The antiplatelet drugs wide used in order to reduce the risk of thrombotic complications have their own features in the case of accompanying inflammation. The participation of platelets from different platelets subpopulations is not well known yet. The aim of this study was to evaluate the effect of antiplatelet therapy on platelets in inflammation. Methods: In our study there were included 36 CHD patients (pts) 1 day after percutaneous coronary intervention (PCI), 12 from whom received GPIIb/IIIa inhibitors, 24 were on the loading dose of clopidogrel, also 11 CHD and pneumonia pts who were taking 75 mg aspirin a day, 14 pts with yersinious taking NAIDs and 18 healthy subjects (HS) free from medications. In all study groups platelets spontaneous and ADP 0.1, 1.0, 5.0 μM aggregation (PA) was measured by using an aggregation analyzer BIOLA (Russia). Platelet morphology and leukocyte-platelet aggregates (LPA) were assessed by scanning electron microscopy. Platelet mean volume (MPV) was estimated by thrombocytocrit method, serum high sensitive CRP (hs-CRP) level was analysed by using nephelometric method. Results: In all pts with inflammation there was 62.7 ± 12.4% of LPA and 4.7 ± 1.3% of large reticulated platelets (LRP), which are normally absent in HS. The presence of LPA and LRP is usual in pts with inflammation. At 64% pts the number of LRP was higher than 2% and that correlated with
C0159 β1 blockers, warfarin and rhythm conversion in atrial fibrillation Ruzan Durgaryan Yerevan No 13 Polyclinic - Nerqin Shengavit 9, 32 Building, Armenia Background: Atrial fibrillation(AF) is the most frequently encountered sustained cardiac arrhythmia in clinical practice and a major cause of morbidity and mortality. Effective treatment of AF still remains an unmet medical need. Treatment of AF is based on drug therapy and ablative strategies. Antiarrhythmic drug therapy is limited by a relatively high recurrence rate and proarrhythmic side effects. Conversion to sinus rhythm(SR) with pharmacological intervention is an actual goal for clinicians though unfortunately not always successful. Methods: 19 female patients have been chosen for trial, all they in postmenopausal period, with previous history of arterial hypertension without valve disease as well as with the first paroxysm of atrial fibrillation and haven't gone to sinus rhythm conversion just after paroxysm. They have been divided into 2 groups for pharmacological intervention either for rhythm control or rate control. 10 patients have been involved in Group1 and 9 patients in Group2. These 2 groups have been adjusted by age, BMI, cholesterol, blood pressure (BP), left ventricular systolic function estimated using left ventricular ejection fraction more than 50%, measured by Simpson and Teichholz method, left atrial diameter less than 50 mm. Group1 has been treated by biseprolol (Coronal), losartan (Sentor), hypochlorthiazide, warfarin with the following mean doses 7,5 mg, 100 mg, 12.5 mg, 3.75 mg respectively. Group2 has been treated by metoprolol tartrate(Egiloc), lisinopril(Diraton), hypochlorthiazide, warfarin with the following mean doses 100 mg, 15 mg, 12.5 mg, 3.75 mg respectively. Dose of warfarin has been chosen to keep INR between 2.0–2.5 before and between 1.5-2 after rhythm conversion, there were no thrombs according to data of transesophageal echocardiography. BP was controlled between normal rages. Results: It has been noticed conversion to SR in 8 patients from 10 in Group1 during 3rd- 4th week of treatment, after amiodaron has been added to treatment. Despite to it in Group2 conversion to SR has been noticed only in 2 patients although there was well rate control in other patients. Any thromboembolic comlication has been noticed neither in Group1 nor in Group2. Comment: In abmulatory practice selective β1 blocker biseprolol which has much less proarrhythmic side effects than other antiarrhythmic drugs can be used for conversion to SR in patient with AF combined with losartan and warfarin, after rhythm conversion treatment can be continued added amiodaron to control the rhythm. INR between 2–2.5 range before and 1.5-2 after rhythm conversion is saved by mean of thromboembolic complications. Although another selective β1 blocker metoprolol can be used for successful rate control. doi:10.1016/j.thromres.2012.08.188
C0409 Prevalence of atrial fibrillation in patients presenting with stroke Uchenna Ozo1, Khalil Peroo2, Gemma Fitzpatrick2, Khalil Kawafi2 1 Fairfield General Hospital, Stroke - FGH, Rochdale Road, Bury, UK; 2 FGH, UK Background: Atrial fibrillation (AF) is a major risk factor in the development of thromboembolic stroke. A significant proportion of these patients are not receiving optimum thromboprophylaxis. Risk
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stratification in AF and subsequent anticoaguation was audited against NICE, SIGN and ESC guidance. Aims/Objectives Identify the incidence of new AF in stroke patients Quantify the prevalence of AF in stroke patients Audit documentation of risk stratification Assess whether anti-coagulation was prescribed according to best practice Methods: All patients with a diagnosis of stroke to the Stroke Unit at Fairfield General Hospital during the period ranging from January to June 2011 (both inclusive) were surveyed.Case notes were reviewed retrospectively and data collected using a specifically designed proforma Results: 272 patients were admitted to the Stroke Unit during a six month. 44 patient (16.2%) met the inclusion criteria, 9 (3.3%) of which were of new onset AF. 42 patients (15.4%) had indications for anticoagulation, four of whom were already on warfarin. The rationale for the failure to anticoagulate was documented in 50% of cases, the commonest reasons being risk of falls and intracranial haemorrhage. A small proportion of patients (12.2%) however failed to receive the correct thrombo-prophylaxis, i.e. warfarin. Around one-fifth (18.2%) died following their stroke. Comment: Risk stratification was not consistently and systematically completed for every patient admitted with AF. CHADS scores were not always calculated, and certainly rarely documented. The development of a clinical pathway for Stroke patients in AF, detailing risk assessment, management and onward referral. Educate medical and nursing teams about risk assessments in AF patient. Re-audit in 6 months to ensure clinical pathway is being adhered to. doi:10.1016/j.thromres.2012.08.189
C0150 The features of antiplatelet therapy in inflammation Liudmila Buryachkovskaya1, Alexander Sumarokov2, Irina Uchitel1 1 Russian Cardiology Research Complex, Department of Thrombosis 3rd Cherepkovskaya, 15A, Moscow, Russia; 2Russian Cardiology Research Complex, Department of Atherosclerosis - 3rd Cherepkovskaya, 15A, Moscow, Russia Background: Platelets are important link between inflammation, thrombosis and atherogenesis. The antiplatelet drugs wide used in order to reduce the risk of thrombotic complications have their own features in the case of accompanying inflammation. The participation of platelets from different platelets subpopulations is not well known yet. The aim of this study was to evaluate the effect of antiplatelet therapy on platelets in inflammation. Methods: In our study there were included 36 CHD patients (pts) 1 day after percutaneous coronary intervention (PCI), 12 from whom received GPIIb/IIIa inhibitors, 24 were on the loading dose of clopidogrel, also 11 CHD and pneumonia pts who were taking 75 mg aspirin a day, 14 pts with yersinious taking NAIDs and 18 healthy subjects (HS) free from medications. In all study groups platelets spontaneous and ADP 0.1, 1.0, 5.0 μM aggregation (PA) was measured by using an aggregation analyzer BIOLA (Russia). Platelet morphology and leukocyte-platelet aggregates (LPA) were assessed by scanning electron microscopy. Platelet mean volume (MPV) was estimated by thrombocytocrit method, serum high sensitive CRP (hs-CRP) level was analysed by using nephelometric method. Results: In all pts with inflammation there was 62.7 ± 12.4% of LPA and 4.7 ± 1.3% of large reticulated platelets (LRP), which are normally absent in HS. The presence of LPA and LRP is usual in pts with inflammation. At 64% pts the number of LRP was higher than 2% and that correlated with