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Case-based Symposium: "Identifying and assessing risk for cerebrovascular disease"

Commented by Vassilis Vassiliou and Maja-Lisa Løchen, Prevention, Epidemiology and Population Science Section members

This Case-based Symposium "Identifying and assessing risk for cerebrovascular disease- Case Demonstrations" was held at EuroPrevent 2018 in Ljubljana and is commented by the two chairpersons.

Risk Factors and Prevention


Chairpersons & Speakers

Chairpersons:

Vassilios Vassiliou and Maja-Lisa Løchen 

Speakers:

  • Panagiota Anna Chousou
  • Igor Zupan
  • Piotr Jankowski
  • Christina Chrysohoou

Comment 

This was a clinically related case-based symposium organised by the Prevention, Epidemiology and Population Science Section.

The talks focused on atrial fibrillation (AF) which is the most important risk factor for stroke and attracted a large audience.

The first talk was given by Dr Anna Chousou from the United Kingdom, who discussed the role of screening for AF in Embolic Stroke of Undetermined Source. Whilst the established use of 24 hour Holter monitors is mandated, Dr Chousou presented robust evidence that in appropriately selected individuals prolonged monitoring with an implantable loop recorder could identify a further 30-40% of patients with AF, who had a normal 24 hour monitor, and who would benefit from anticoagulation. The median time to detection of AF has been shown to be as long as 112 days, much longer than the usual 7 or 30 day monitoring that most institutions use.

The second talk was given by Prof Igor Zupan from Slovenia, who discussed how we can recognise and define AF from device recordings, such as pacemakers and implantable cardioverter defibrillators (ICDs) based on identification of atrial high rate episodes, and indications for anticoagulation. It is important to monitor all the patients with implanted devices and for those who have AF for more than 24 hours anticoagulation should be considered. The evidence is less clear for the patients who have infrequent AF lasting less than 24 hours. Until this evidence becomes available the risk of thromboembolism calculated with the CHADS-VASc score could be considered and the threshold of anticoagulation lowered for those at higher risk.

This talk was followed by Dr Piotr Jankowski from Poland, who discussed the prevention of AF by controlling hypertension. Managing hypertension with ACE inhibitors and angiotensin II blockers as first line is widely accepted. Beta blockers and rate limiting calcium channel blockers can also be helpful especially if rate control is required, but also mineralocorticoid inhibition has an important role.

Finally, the session was concluded by a talk given by Dr Christina Chrysohoou from Greece, on the anticoagulation of patients with AF after acute coronary syndromes and intervention. There is sufficient evidence that dual therapy with dabigatran and a P2Y12 Inhibitor causes less bleeding that the standard triple therapy of warfarin, aspirin and P2Y12 Inhibitor, and should therefore be considered.  

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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The Case-based Symposium "Identifying and assessing risk for cerebrovascular disease- Case Demonstrations" was held at EuroPrevent 2018 in Ljubljana.

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