title: Antithrombotic management of stroke patients before colonoscopy.
abstract: BACKGROUND
  Uncertainty exists regarding the management of antithrombotic medications in ischemic stroke and transient ischemic attack (TIA) patients around the time of colonoscopy. We sought to evaluate whether there was a difference in adverse events among patients who continued medications and those who had temporary discontinuation.
  
  
  METHODS
  Using a hospital administrative database, electronic charts of patients with a diagnostic code for stroke or TIA and a procedural code for colonoscopy were reviewed. Information collected included baseline demographics, medical history, and antithrombotic medications. Outcome measures were stroke (ischemic and hemorrhagic), myocardial infarction, venous thromboembolism, and major systemic bleeding (i.e., requiring transfusion) up to 4 weeks after the procedure among patients who had medications continued versus temporarily discontinued.
  
  
  RESULTS
  One hundred seventy-seven patients met inclusion criteria. Antithrombotic medication was temporarily discontinued in 42 patients and continued in 135 patients. Comparing patients who had medications held to those who had medications continued, stroke occurred in 1 (2.4%) versus 0 (0%; P = .237) patients; myocardial infarction in no patients in either group; venous thromboembolism in 0 (0%) versus 1 (0.7%; P > .99) patients; and major system bleeding in 2 (4.8%) versus 4 (3.0%; P = .628) patients.
  
  
  CONCLUSIONS
  In this retrospective analysis, there was no significant difference in the occurrence of stroke, myocardial infarction, venous thromboembolism, and major bleeding between patients who had medications continued around the time of colonoscopy versus those who had temporary discontinuation. A prospective, randomized controlled study is warranted to further elucidate this issue.
authors.affiliation: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Basel
authors.initials: B
authors.lastname: Assaad
authors.forename: Veronica Kemerko
authors.initials: VK
authors.lastname: Sesi
authors.forename: Renzo
authors.initials: R
authors.lastname: Figari
authors.forename: Lonni
authors.initials: L
authors.lastname: Schultz
authors.forename: Nithin
authors.initials: N
authors.lastname: Thummala
authors.forename: Mohammed
authors.initials: M
authors.lastname: Rehman
authors.forename: Arun
authors.initials: A
authors.lastname: Chandok
authors.forename: Ann
authors.initials: A
authors.lastname: Silverman
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D054556:Venous Thromboembolism / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents