Effect of Discontinuing Aspirin Therapy on the Risk of Brain Ischemic Stroke

Maulaz, Alexandre B.; Bezerra, Daniel C.; Michel, Patrik; Bogousslavsky, Julien

doi:10.1001/archneur.62.8.1217

Cited by 270 publications

(146 citation statements)

References 20 publications

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“…Acute cardiac events are noted within 10 days of ASA withdrawal and are due to coronary thrombosis. There are also clinical and experimental data that the "rebound thrombosis phenomenon" increases cerebrovascular event rates as well (13). These findings support the recommendation to restart ASA treatment within 8-10 days after a major procedure for which ASA withdrawal was deemed necessary.…”

Section: Commentssupporting

confidence: 64%

Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin

et al. 2010

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Purpose: To determine whether the peri-procedural administration of low-dose aspirin increases the risk of bleeding complications for patients undergoing extended prostate biopsies. Materials and Methods: From February 2007 to September 2008, 530 men undergoing extended needle biopsies were divided in two groups; those receiving aspirin and those not receiving aspirin. The morbidity of the procedure, with emphasis on hemorrhagic complications, was assessed prospectively using two standardized questionnaires. Results: There were no significant differences between the two groups regarding the mean number of biopsy cores (12.9 ± 1.6 vs. 13.1 ± 1.2 cores, p = 0.09). No major biopsy-related complications were noted. Statistical analysis did not demonstrate significant differences in the rate of hematuria (64.5% vs. 60.6%, p = 0.46), rectal bleeding (33.6% vs. 25.9%, p = 0.09) or hemospermia (90.1% vs. 86.9%, p = 0.45). The mean duration of hematuria and rectal bleeding was significantly greater in the aspirin group compared to the control group (4.45 ± 2.7 vs. 2.4 ± 2.6, p = < 0.001 and 3.3 ± 1.3 vs. 1.9 ± 0.7, p < 0.001). Multivariate logistic regression analysis revealed that only younger patients (mean age 60.1 ± 5.8 years) with a lower body mass index (< 25 kg/m 2 ) receiving aspirin were at a higher risk (odds ratio = 3.46, p = 0.047) for developing hematuria and rectal bleeding after the procedure. Conclusions: The continuing use of low-dose aspirin in patients undergoing extended prostatic biopsy is a relatively safe option since it does not increase the morbidity of the procedure.

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Section: Commentssupporting

confidence: 64%

Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin

et al. 2010

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“…106 107 Caution is required if aspirin therapy is interrupted when prescribed for secondary prophylaxis due to the high risk of thrombotic events. [34][35][36] The association of thienopyridene or aspirin use with the risk of post-ESD bleeding has been examined in several studies of gastric ESD. These studies are, however, retrospective single-centre case studies with a variety of APAs, and differences in regimens for discontinuing or continuing therapy.…”

Section: Polypectomy On Antithrombotic Therapymentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Vanbiervliet²,

et al. 2017

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“…Our findings did not greatly differ from the previous studies; AMI occurred in 1 patient (4.3%) in the discontinuation group. With respect to the period from the withdrawal of antithrombotic agents to the occurrence of thromboembolic events, one study reported that about 70% of post-withdrawal cerebral infarctions occurred within 10 days after withdrawal (5), and the PRoFESS study sub-analysis found that there was a significantly higher stroke recurrence rate within 1 week after the withdrawal of antiplatelet agents (6). In the present study, the patient in the discontinuation group who suffered AMI had discontinued all antithrombotic agents (aspirin and ticlopidine) 1 week earlier and was receiving heparin bridging therapy, but suffered AMI on the day of the procedure (7th day of withdrawal), a similar result to previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, if the antithrombotic agent is continued, perioperative thrombosis and embolism can be prevented, but the risk of bleeding increases. It has been reported that the cessation of warfarin results in serious thromboembolism in 1% of patients and death in 80% of this 1%; the cessation of aspirin leads to a 3.4-fold increase in the odds ratio for cerebral infarc-tion (4,5). A sub-analysis in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) study of secondary stroke prevention also found that cessation of antiplatelet agents resulted in approximately a 5-fold increase in the incidence of stroke recurrence within one week (6).…”

Section: Introductionmentioning

confidence: 99%

Safety and Management of Antithrombotic Therapy with Intra-Arterial Catheter Procedures

et al. 2015

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Objective Intravascular catheter procedures are often performed in patients undergoing antithrombotic therapy. However, methods for the management of antithrombotic agents in the perioperative period are currently unclear. Therefore, the safety and management of antithrombotic agents in these patients were investigated. Methods A prospective, multicenter, observational study [Management of Antithrombotic Agents During Surgery or Medical Procedures with Bleeding (MARK study)] at 58 National Hospital Organization institutions in Japan was performed. 1,040 patients were enrolled in the MARK study and underwent an intravascular catheter procedure. For all participants, the details of the procedure, method of perioperative management of antithrombotic agents, and occurrence of thrombosis, embolism, and bleeding complications during the study period were investigated. Results The use of antithrombotic agents was continued in 1,017 patients (98%, continuation group) and discontinued in the other 23 (2%, discontinuation group). Continuation of the antithrombotic agents did not have a significant effect on the overall occurrence of thromboembolism [hazard ratio (HR), 0.15; p=0.08] or bleeding events (HR, 0.19; p=0.12). However, the overall adverse event risk was significantly lower in the continuation group than in the discontinuation group (HR, 0.18; p=0.03). Conclusion It is both safe and appropriate to perform intravascular catheter procedures in patients continuing with antithrombotic therapy.

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Effect of Discontinuing Aspirin Therapy on the Risk of Brain Ischemic Stroke

Cited by 270 publications

References 20 publications

Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin

Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Safety and Management of Antithrombotic Therapy with Intra-Arterial Catheter Procedures

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