Stroke and transient ischemic attacks related to antiplatelet or warfarin interruption

Abstract

Patients on anticoagulant or antiplatelet therapy are often required to discontinue these medications before and during surgical or invasive procedures. In some cases, the patient stops the treatment without medical supervision. These situations may increase stroke risk. Objective To identify the ischemic stroke and transient ischemic attack (TIA) prevalence related to length of time of discontinuation of antiplatelet or vitamin K antagonist therapy, in a group of inpatients from a specialized neurological hospital in Brazil. Methods Cross-sectional, retrospective and descriptive study of stroke inpatients for three years. Medical reports were reviewed to find study participants, stroke characteristics, risk factors, reasons and time of drug interruption. Results In three years, there were 360 stroke and TIA inpatients, of whom 27 (7.5%) had a history of antiplatelet or vitamin K antagonist interruption correlated with the time of the event (81% ischemic stroke, 19% TIA). The median time between antiplatelet interruption and an ischemic event was five days, and 62% of events occurred within seven days after drug suspension. For vitamin K antagonists, the average time to the ischemic event was 10.4 days (SD = 5.7), and in 67% of patients, the time between drug discontinuation and the event was 7-14 days. The most frequent reason for drug suspension was patient negligence (37%), followed by planned surgery or invasive examination (26%) and side effects, including hemorrhage (18.5%). Conclusion Antiplatelet or vitamin K antagonist suspension has a temporal relationship with the occurrence of stroke and TIA. Since these events are preventable, it is crucial that healthcare professionals convince their patients that drug withdrawal can cause serious consequences.

Oral anticoagulant interruption and stroke: are we doing our best?

“…In a multicenter trial carried out in 11 Korean centers over 2 years, 3213 consecutive acute ischaemic stroke patients with atrial fibrillation were surveyed and studied. The main finding in the study was that about 7.1% of stroke patients with atrial fibrillation experienced OAC interruption and that recurrent infarction during OAC withdrawal developed in 4.0% of overall OAC interruption cases, reinforcing previous evidence [2].…”

Incidence of oral anticoagulant interruption among stroke patients with atrial fibrillation and subsequent stroke

“…A recent randomized trial and registry‐based study investigating the efficacy of bridging anticoagulation prior to elective operation or procedure among patients with atrial fibrillation reported that thromboembolic risk during OAC withdrawal was 0.4%, where the proportion of previous stroke among included patients was 15–17% . However, studies among stroke patients reported that ischaemic stroke associated with OAC interruption constituted about 3.6–7.5% .…”

Crioterapia no controle da espasticidade em pacientes com sequelas de acidente vascular encefalico

“…Visto que o fornecimento de sangue se restabelece rapidamente, o tecido cerebral não sofre tantos danos. 13 As lesões no córtex cerebral ou no feixe córtico-espinhal, provenientes do AVE, acometem as conexões corticais com a medula, tronco encefálico e cerebelo, enquanto as demais áreas supra-medulares mantem exercendo um controle sobre a atividade dos motoneurônios inferiores. Como resultado, há uma ativação muscular anormal que produz um sério comprometimento motor.…”