University of Cincinnati, Department of Neurology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center MSB #0525, Cincinnati, OH 45242, USA.
Stroke. 2011 Sep;42(9):2509-14. doi: 10.1161/STROKEAHA.110.611905. Epub 2011 Jun 30.
Antithrombotic medications (anticoagulants and antiplatelets) are often withheld in the periprocedural period and after bleeding complications to limit the risk of new or recurrent bleeding. These medications are also stopped by patients for various reasons such as cost, side effects, or unwillingness to take medication.
Patient records from the population-based Greater Cincinnati/Northern Kentucky Stroke Study were reviewed to identify cases of ischemic stroke in 2005 and determine the temporal association of strokes with withdrawal of antithrombotic medication. Ischemic strokes and reasons for medication withdrawal were identified by study nurses for subsequent physician review.
In 2005, 2197 cases of ischemic stroke among residents of the region were identified through hospital discharge records. Of the 2197 ischemic strokes, 114 (5.2%) occurred within 60 days of an antithrombotic medication withdrawal, 61 (53.5%) of these after stoppage of warfarin and the remainder after stoppage of an antiplatelet medication. Of the strokes after withdrawal, 71 (62.3%) were first-ever and 43 (37.7%) were recurrent; 54 (47.4%) occurred after withdrawal of medication by a physician in the periprocedural period.
The withdrawal of antiplatelet and antithrombotic medications in the 60 days preceding an acute ischemic stroke was associated with 5.2% of ischemic strokes in our study population. This finding emphasizes the need for thoughtful decision-making concerning antithrombotic medication use in the periprocedural period and efforts to improve patient compliance.
抗血栓药物（抗凝剂和抗血小板药物）常在围手术期和出血并发症后被停用，以降低新发或复发性出血的风险。这些药物也因各种原因被患者停用，如费用、副作用或不愿服药。
对基于人群的辛辛那提/北肯塔基州卒中研究的患者记录进行了回顾，以确定 2005 年缺血性卒中病例，并确定卒中与抗血栓药物停药之间的时间关联。缺血性卒中及停药原因由研究护士确定，随后由医生进行审查。
2005 年，通过医院出院记录，在该地区居民中发现了 2197 例缺血性卒中。在这 2197 例缺血性卒中中，有 114 例（5.2%）发生在抗血栓药物停药后 60 天内，其中 61 例（53.5%）在华法林停药后，其余在抗血小板药物停药后。在停药后发生的卒中中，有 71 例（62.3%）为首发，43 例（37.7%）为复发；54 例（47.4%）发生在围手术期医生停药后。
在急性缺血性卒中前 60 天内停用抗血小板和抗血栓药物与我们研究人群中 5.2%的缺血性卒中有关。这一发现强调了在围手术期谨慎决策使用抗血栓药物的必要性，并需要努力提高患者的依从性。
