Abstract TP414: Cerebral Infarction After Antithrombotics Withdrawal and Its Impact on Clinical Outcome
Background: The cessation of antithrombotic agent is related with increased thromboembolic events. However, the clinical characteristics of stroke after antithrombotics withdrawal and its impact on stroke outcome have not been studied. In this study we tried to evaluate clinical significance of antithrombotics withdrawal in stroke occurrence and outcome.
Methods: Between January 1st 2009, and March 1st 2012, the acute stroke patients who admitted in Seoul National University Hospital within seven days after symptom onset were eligible in the study. We defined stroke after antithrombotics withdrawal (SAW) as those stroke patients who had maintained antiplatelet agent or anticoagulant regularly but ceased their medication before stroke onset. We reviewed their clinical characteristics as well as the reason of medication cessation, type of medication, and duration between medication hold and stroke onset. To evaluate the effect of antithrombotics withdrawal in stroke outcome, we compared SAW with stroke patients which occurred on regular medication.
Results: Among 1635 acute stroke patients, 84 patients (5.2%) were identified as SAW during the inclusion period, with a mean age of 68.0±13.2 years including 49 male patients. The most common cause of medication cessation is poor compliance in 32 patients (37.7%), followed by pre-operation/procedure hold in 24, antithrombotics complication in 16, and doctor’s decision in 13. The 42 patients with SAW who had stroke within one month after medication cessation were compared with 261 patients who experienced cerebral infarction during regular medication. Stroke progression defined as 3 or more NIHSS worsening during admission was more prevalent in SAW patients than in patients with regular medication (14.3% vs. 5.0%, p=0.042). The patients with poor functional outcome defined as mRS of 5 and 6 at discharge were more common in SAW than in patients with regular medication (16.7% vs. 6.5%, p=0.043).
Conclusion: This study shows that 5.2% of total stroke is due to medication withdrawal, and poor compliance is the most common cause of antithrombotics hold. Stroke after antithrombotics hold is associated with higher rate of stroke progression and poor outcome, implying exacerbated thromboembolic state.
- © 2012 by American Heart Association, Inc.