title: Withdrawal of antithrombotic agents and its impact on ischemic stroke occurrence.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: University of Cincinnati, Department of Neurology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center MSB #0525, Cincinnati, OH 45242, USA. joseph.broderick@uc.edu
authors: Joseph P
authors: JP
authors: Broderick
authors: Jordan B
authors: JB
authors: Bonomo
authors: Brett M
authors: BM
authors: Kissela
authors: Jane C
authors: JC
authors: Khoury
authors: Charles J
authors: CJ
authors: Moomaw
authors: Kathleen
authors: K
authors: Alwell
authors: Daniel
authors: D
authors: Woo
authors: Matthew L
authors: ML
authors: Flaherty
authors: Pooja
authors: P
authors: Khatri
authors: Opeolu
authors: O
authors: Adeoye
authors: Simona
authors: S
authors: Ferioli
authors: Dawn O
authors: DO
authors: Kleindorfer
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007629:Kentucky; D008297:Male; D009820:Ohio; D010349:Patient Compliance; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage*; D028761:Withholding Treatment
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin