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Stroke risk related to intentional discontinuation of antithrombotic therapy for invasive procedures
Nobuyuki Mitsui1, Manabu Kinoshita1, Jun Sawada2
11Department of Neurosurgery, Asahikawa Medical University.
Insights
Discontinuing antithrombotic therapy for procedures increases cerebral ischemic event risk. Patients on dual therapy face a significantly higher risk, though overall risk remains low.
Area of Science:
- Cardiology
- Neurology
- Clinical Medicine
Background:
- Antithrombotic medications are crucial for preventing thrombotic events but complicate invasive procedures.
- Discontinuation is necessary to mitigate bleeding risks but may elevate ischemic risks.
Purpose of the Study:
- To quantify the increased risk of cerebral ischemic events in patients requiring antithrombotic therapy discontinuation during hospitalization for procedures.
Main Methods:
- A single-center retrospective observational study.
- Data collected from patients admitted between January 1, 2021, and December 31, 2022.
- Identification of patients discontinuing antithrombotics and those experiencing cerebral ischemia.
Main Results:
- Among 835 patients undergoing procedures, 2 cases of cerebral ischemia occurred (0.24% incidence).
- This incidence was significantly higher than incidental in-hospital strokes (p=0.04).
- Patients on combined anticoagulation and antiplatelet therapy showed a significantly higher risk of cerebral ischemia (p<0.0001).
Conclusions:
- Discontinuing antithrombotic therapy for elective procedures carries a small but statistically significant increased risk of cerebral ischemia.
- The risk is notably higher for patients on dual antithrombotic therapy.
- While the absolute risk is low, careful consideration is warranted for patients requiring antithrombotic cessation.
Objective:
Antithrombotic medications pose a challenge for conducting surgical or invasive procedures, because their discontinuation is required to avoid postprocedural hemorrhagic complications but potentially increases the ischemic risk for the patient. This study aimed to estimate the increased risk of developing cerebral ischemic events during hospitalization requiring discontinuation of antithrombotic therapy.
Methods:
This investigation was a single-center retrospective observational study. Clinical data in patients scheduled for admission between January 1, 2021, and December 31, 2022, were collected. Patients requiring discontinuation of antithrombotic therapy were identified by referring to the admission database. Patients who developed cerebral ischemia were identified by referring to the institution's stroke center database.
Results:
Seven hundred ninety-six patients scheduled for nonneurosurgical procedures and 39 scheduled for neurosurgical procedures underwent discontinuation of antithrombotic therapy. Anticoagulation therapy was prescribed in 40.0%, and antiplatelet therapy was prescribed in 69.1% of the patients. A total of 9.2% of the entire cohort of patients were receiving both anticoagulation and antiplatelet therapy. Bridging therapy was administered in 20.9% of nonneurosurgical patients. No ischemic event was observed in the patients undergoing neurosurgical procedures. Among the entire cohort, 3 patients encountered some kind of thrombotic event-2 of which were cerebral ischemia-accounting for an incidence of 0.24%, which was significantly higher than incidental in-hospital stroke unrelated to discontinuation of antithrombotic therapy (p = 0.04). Patients undergoing both anticoagulation and antiplatelet therapy harbored a significantly higher risk for cerebral ischemia related to discontinuation of antithrombotic therapy (p < 0.0001).
Conclusions:
Discontinuing antithrombotic therapy during hospitalization for elective invasive procedures-including neurosurgical procedures-entailed a relatively small risk of developing cerebral ischemic events, but the risk was significantly higher compared to hospitalized patients without discontinuation of antithrombotic therapy.
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