P79 | Subclinical atrial fibrillation in embolic stroke of undetermined source: management and stroke recurrence

Premises and Purpose of the study: Subclinical atrial fibrillation (SAF) represents the most frequent underlying etiology after embolic stroke of undetermined source (ESUS) and its research is strongly recommended in the diagnostic work-up. Whether oral anticoagulation (OA) reduce the risk of stroke recurrence after SAF is unknown. The aim of our study was to analyze management of secondary antithrombotic prophylaxis and the rate of 12-month stroke recurrence in real life ESUS patients.Materials and Methods: We retrospectively analyzed data of ESUS patients who underwent non implantable 2-week ECG monitoring after discharge. Episodes of SAF of any duration were considered diagnostic. Antithrombotic treatment at hospital discharge and after ECG monitoring, and 12-month recurrence were registered. We compared the rate of stroke recurrence between patients with and without SAF.Results: 159 patients (75 females), median age 73.5 (66.75-79) years, were the study population. At hospital discharge 96.9% of patients received antiplatelet therapy. SAF was detected in 82 patients (51.5%). OA was prescribed in 98.6% of them. Median time from stroke onset to OA prescription was 143 (IQR 94-178) days. Overall, 12-month stroke recurrence occurred in 8 patients (5%), with a not significant lower rate in patients who were prescribed OA compared to those who were not (3.7% vs. 6.25%, p=0.7202).Conclusions: OA prescribed after SAF detection in patients with ESUS reduced, but not significantly, the risk of stroke recurrence. Future research and prospective multicentric studies are warranted.