Withdrawal of Antithrombotic Agents and Its Impact on Ischemic Stroke Occurrence

TLDR

Antithrombotic agents are frequently withheld around procedures or after bleeding events and also discontinued by patients for cost, side effects, or reluctance, creating a common pattern of medication withdrawal. The study aimed to determine whether withdrawal of antithrombotic therapy is temporally linked to ischemic stroke events in the Greater Cincinnati/Northern Kentucky region during 2005. Researchers retrospectively reviewed 2,197 ischemic stroke cases from hospital discharge records, with study nurses identifying strokes and reasons for antithrombotic discontinuation for physician adjudication. Withdrawal of antithrombotic medication within 60 days preceded 5.2% of ischemic strokes, with over half occurring after warfarin cessation, underscoring the importance of careful peri‑procedural management and patient adherence.

Abstract

Antithrombotic medications (anticoagulants and antiplatelets) are often withheld in the periprocedural period and after bleeding complications to limit the risk of new or recurrent bleeding. These medications are also stopped by patients for various reasons such as cost, side effects, or unwillingness to take medication.Patient records from the population-based Greater Cincinnati/Northern Kentucky Stroke Study were reviewed to identify cases of ischemic stroke in 2005 and determine the temporal association of strokes with withdrawal of antithrombotic medication. Ischemic strokes and reasons for medication withdrawal were identified by study nurses for subsequent physician review.In 2005, 2197 cases of ischemic stroke among residents of the region were identified through hospital discharge records. Of the 2197 ischemic strokes, 114 (5.2%) occurred within 60 days of an antithrombotic medication withdrawal, 61 (53.5%) of these after stoppage of warfarin and the remainder after stoppage of an antiplatelet medication. Of the strokes after withdrawal, 71 (62.3%) were first-ever and 43 (37.7%) were recurrent; 54 (47.4%) occurred after withdrawal of medication by a physician in the periprocedural period.The withdrawal of antiplatelet and antithrombotic medications in the 60 days preceding an acute ischemic stroke was associated with 5.2% of ischemic strokes in our study population. This finding emphasizes the need for thoughtful decision-making concerning antithrombotic medication use in the periprocedural period and efforts to improve patient compliance.