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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Stroke and transient ischemic attacks related to antiplatelet or warfarin interruption
Vanessa Rizelio1, Andre Luiz Borba Macuco1, Henry Koiti Sato1
1Instituto de Neurologia de Curitiba; Curitiba PR, Brasil.
Insights
Discontinuing antiplatelet or vitamin K antagonist therapy increases stroke and transient ischemic attack (TIA) risk. Most events occur within days or weeks of stopping medication, highlighting the need for patient education on risks.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Patients on anticoagulant or antiplatelet therapy often stop medication for procedures.
- Unsupervised discontinuation can elevate stroke risk.
- Understanding the link between drug cessation and ischemic events is crucial.
Purpose of the Study:
- To determine the prevalence of ischemic stroke and transient ischemic attack (TIA).
- To analyze the relationship between the duration of antiplatelet or vitamin K antagonist therapy interruption and event occurrence.
- To investigate this relationship in Brazilian inpatients.
Main Methods:
- A cross-sectional, retrospective, and descriptive study was conducted.
- Medical reports of stroke inpatients over three years were reviewed.
- Data collected included stroke characteristics, risk factors, and reasons/timing of drug interruption.
Main Results:
- Out of 360 stroke and TIA inpatients, 27 (7.5%) had interrupted therapy.
- For antiplatelets, the median time to an ischemic event was 5 days (62% within 7 days).
- For vitamin K antagonists, the average time to an ischemic event was 10.4 days (67% between 7-14 days). Patient negligence was the most common reason for discontinuation.
Conclusions:
- There is a clear temporal relationship between antiplatelet/vitamin K antagonist suspension and stroke/TIA occurrence.
- These events are preventable.
- Healthcare professionals must educate patients on the serious consequences of drug withdrawal.
Objective:
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. 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.
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