title: Withdrawal of Antithrombotic Agents and the Risk of Stroke.
abstract: OBJECTIVE
  Antithrombotic medications are effective for ischemic stroke prevention, but stoppage of these medications is associated with an increased risk of thromboembolism. The frequency of antithrombotic withdrawal in the general population is unknown.
  
  
  METHODS
  We conducted a random phone sample of 2036 households in the Greater Cincinnati metropolitan area, representative of the stroke population by age, sex, and race, to determine the frequency of antithrombotic medication use and stoppage by physicians for medically indicated procedures.
  
  
  RESULTS
  Sixty-two percent of survey respondents reported that they were on an antithrombotic medication. Ten percent of participants reported that they had stopped taking their medication within the past 60 days for a medically indicated intervention. Of those who stopped taking the medication, it was more common for persons taking an anticoagulant to stop their medication (20%) than those taking an antiplatelet agent (9%). Colonoscopies and orthopedic surgeries were the most common reasons for withdrawal of antiplatelet agents, whereas orthopedic and vascular surgeries were the most common reason for withdrawal of anticoagulants.
  
  
  CONCLUSIONS
  Recommended discontinuation of antithrombotic medication for surgical or diagnostic procedures is common practice for persons in the community representative of a stroke population. Because stoppage of these medications is associated with an increased risk of thromboembolic stroke, further clinical trials are needed to determine best management practices in this setting.
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: wagnemi@mail.uc.edu.
authors.forename: Monica L
authors.initials: ML
authors.lastname: Wagner
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Khoury
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Alwell
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Eric
authors.initials: E
authors.lastname: Rademacher
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Flaherty
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Anderson
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Simona
authors.initials: S
authors.lastname: Ferioli
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology*; D013689:Telephone; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Ischemic stroke; anticoagulant; antiplatelet; antithrombotic; discontinuation; survey; thromboembolism; withdrawal
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