Abstract 11478: Ischemic Stroke After Antithrombotics Withdrawal and Its Impact on Neurological Deterioration
Introduction: Clinical characteristics of stroke after antithrombotics withdrawal and functional outcome have not been studied.
Hypothesis: 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 included. We defined stroke after antithrombotics withdrawal (SAW) as those patients who had maintained antiplatelet or anticoagulant regularly but ceased their medication before stroke onset within 60 days. We reviewed their clinical characteristics as well as the reason of medication cessation, type of medication, and duration between medications hold and stroke onset. To evaluate the effect of antithrombotics withdrawal in stroke outcome, we compared SAW with those patients who experienced stroke on regular medication.
Results: Among 1635 acute stroke patients, 53 patients (3.6%) were identified as SAW during the inclusion period, with a mean age of 66.4±11.3 years. The most common cause of medication cessation is procedure/operation related hold in 24 patients (45.3%), followed by poor compliance in 14, doctor’s decision in 10 and antithrombotics complication in 5. The 53 patients with SAW were compared with 571 patients who experienced cerebral infarction during regular medication. Neurological deterioration defined as 2 or more NIHSS worsening during admission was more prevalent in SAW patients than in patients with regular medication (15.1% vs. 6.3%, p=0.033). Multivariate logistic regression analysis including stroke subtypes, fasting blood sugar>8mmol/L, initial NIHSS>18, symptomatic hemorrhage and antithrombotics hold to predict neurological deterioration disclosed that antithrombotics hold independently predicted neurological deterioration (odds ratio=2.71, confidence interval=1.13-6.50, p=0.026).
Conclusions: This study shows that 3.6% of total stroke is due to medication withdrawal. Stroke after antithrombotics withdrawal is associated with higher rate of neurological worsening.
Author Disclosures: J. Kim: None. K. Jung: None. T. Kim: None. K. Lee: None. H. Park: None. K. Chu: None.
- © 2014 by American Heart Association, Inc.