Risk of Ischemic Stroke in High Risk Atrial Fibrillation Patients during Periods of Warfarin Discontinuation for Surgical Procedures

Qureshi, Adnan I.; Jahangir, Nauman; Malik, Ahmed; Afzal, Mohammad Rauf; Orfi, Fayyaz; Suri, M. Fareed K.

doi:10.1159/000446406

Cited by 5 publications

(1 citation statement)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A more recent study on the risk of ischemic stroke in high risk atrial fibrillation patients 65 years old or older, with at least one additional risk factor for ischemic stroke, in whom warfarin was discontinued for surgical procedures, showed a higher rate of ischemic stroke in the warfarin-discontinued group (1.1% of 265 versus 0.4% of 71,355), a population attributable risk of 23.1% 15 .…”

Section: Does Interruption Of Anticoagulant and Antiplatelet Drugs Have A Prothrombotic Effect?mentioning

confidence: 99%

Stroke and transient ischemic attacks related to antiplatelet or warfarin interruption

Rizelio

Macuco

Sato

et al. 2019

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Patients on anticoagulant or antiplatelet therapy are often required to discontinue these medications before and during surgical or invasive procedures. In some cases, the patient stops the treatment without medical supervision. These situations may increase stroke risk. Objective To identify the ischemic stroke and transient ischemic attack (TIA) prevalence related to length of time of discontinuation of antiplatelet or vitamin K antagonist therapy, in a group of inpatients from a specialized neurological hospital in Brazil. Methods Cross-sectional, retrospective and descriptive study of stroke inpatients for three years. Medical reports were reviewed to find study participants, stroke characteristics, risk factors, reasons and time of drug interruption. Results In three years, there were 360 stroke and TIA inpatients, of whom 27 (7.5%) had a history of antiplatelet or vitamin K antagonist interruption correlated with the time of the event (81% ischemic stroke, 19% TIA). The median time between antiplatelet interruption and an ischemic event was five days, and 62% of events occurred within seven days after drug suspension. For vitamin K antagonists, the average time to the ischemic event was 10.4 days (SD = 5.7), and in 67% of patients, the time between drug discontinuation and the event was 7-14 days. The most frequent reason for drug suspension was patient negligence (37%), followed by planned surgery or invasive examination (26%) and side effects, including hemorrhage (18.5%). Conclusion Antiplatelet or vitamin K antagonist suspension has a temporal relationship with the occurrence of stroke and TIA. Since these events are preventable, it is crucial that healthcare professionals convince their patients that drug withdrawal can cause serious consequences.

show abstract

Section: Does Interruption Of Anticoagulant and Antiplatelet Drugs Have A Prothrombotic Effect?mentioning

confidence: 99%

Stroke and transient ischemic attacks related to antiplatelet or warfarin interruption

Rizelio

Macuco

Sato

et al. 2019

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

Perioperative Management of Antithrombotic Therapy

Douketis

Spyropoulos

Murad

et al. 2022

CHEST

144

111

View full text Add to dashboard Cite

Perioperative care of patients with recent stroke undergoing nonemergent, nonneurological, noncardiac, nonvascular surgery: a systematic review and meta-analysis

Lele,

Moreton,

Sundararajan

et al. 2024

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of review To systematically review and perform a meta-analysis of published literature regarding postoperative stroke and mortality in patients with a history of stroke and to provide a framework for preoperative, intraoperative, and postoperative care in an elective setting. Recent findings Patients with nonneurological, noncardiac, and nonvascular surgery within three months after stroke have a 153-fold risk, those within 6 months have a 50-fold risk, and those within 12 months have a 20-fold risk of postoperative stroke. There is a 12-fold risk of in-hospital mortality within three months and a three-to-four-fold risk of mortality for more than 12 months after stroke. The risk of stroke and mortality continues to persist years after stroke. Recurrent stroke is common in patients in whom anticoagulation/antiplatelet therapy is discontinued. Stroke and time elapsed after stroke should be included in the preoperative assessment questionnaire, and a stroke-specific risk assessment should be performed before surgical planning is pursued. Summary In patients with a history of a recent stroke, anesthesiology, surgery, and neurology experts should create a shared mental model in which the patient/surrogate decision-maker is informed about the risks and benefits of the proposed surgical procedure; secondary-stroke-prevention medications are reviewed; plans are made for interruptions and resumption; and intraoperative care is individualized to reduce the likelihood of postoperative stroke or death.

show abstract

Risk of Ischemic Stroke in High Risk Atrial Fibrillation Patients during Periods of Warfarin Discontinuation for Surgical Procedures

Cited by 5 publications

References 25 publications

Stroke and transient ischemic attacks related to antiplatelet or warfarin interruption

Stroke and transient ischemic attacks related to antiplatelet or warfarin interruption

Perioperative Management of Antithrombotic Therapy

Perioperative care of patients with recent stroke undergoing nonemergent, nonneurological, noncardiac, nonvascular surgery: a systematic review and meta-analysis

Contact Info

Product

Resources

About