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Medication withdrawal may be associated with stroke events
The annual burden could be comparable to that of subarachnoid hemorrhage.
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The perioperative discontinuation of anticoagulant and antiplatelet medication in patients with stroke may be associated with additional stroke burden, study results suggested.
Researchers for the study examined data from the Greater Cincinnati/Northern Kentucky Stroke Study, which measured temporal trends in the incidence rates and stroke outcomes in a biracial population of about 1.3 million people. The researchers included 2,082 patients in the analysis who suffered from 2,191 strokes in 2005.
According to figures presented at the American Stroke Association International Stroke Conference 2009 by Jordan B. Bonomo, MD, an instructor of clinical emergency medicine at the University of Cincinnati, 1,117 of the patients who had strokes were on anticoagulation or antiplatelet medication, and 84 patients (3.4%) stopped medication within 60 days of a stroke event. The researchers then extrapolated the association between discontinued medication and stroke events to the approximately 692,000 strokes that represented the overall annual stroke burden for the United States.
“The withdrawal of antithrombotic and antiplatelet medication in the 60 days preceding ischemic stroke is potentially associated with 26,500 strokes annually, a number which is actually greater than the total subarachnoid hemorrhage burden in the United States,” Bonomo said in his presentation. “It is likely that our burden is actually underestimated, especially in relation to aspirin. These data mandate continued review of the guidelines for withdrawal of anticoagulation and antiplatelet medication in the area of stroke.”
For more information:
- Bonomo J. #157. Presented at: International Stroke Conference; Feb. 17-20, 2009; San Diego.
Dr. Bonomo and colleagues have pointed out a growing dilemma in medical practice. With the aging population, the number of patients who are on antiplatelet or anticoagulation therapy is growing. Discontinuation of antithrombotic medication would put the patient back to a prothrombotic state. Therefore, it would be necessary to minimize the duration of medication withdrawal to decrease such a risk. Discontinuation of antithrombotic medication two months prior to surgery seems to be excessive. Considering the half-life of platelets, discontinuation of antiplatelet therapy for seven to ten days would be generally sufficient while warfarin would lose its effect two to five days after discontinuation.
Further retroactive and prospective studies are needed to unravel the significance of the risk of discontinuation of antiplatelet/anticoagulation therapies in regard to: duration of withdrawal; first-ever vs. recurrent episodes of stroke; the location and severity of stroke and other comorbid conditions; and dual antiplatelet/anticoagulant therapy for patients who are subjected to an endovascular procedure.
– Afshin A. Divani, PhD
Director of Stroke Research
Minnesota Stroke
Initiative, University of Minnesota, Minneapolis