Stroke: does interrupting antiplatelet therapy raise CV risk?

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Takeaway

  • Discontinuation of antiplatelet therapy is not significantly associated with increased risk for cardiovascular event in patients with acute ischemic stroke.

Why this matters

  • Antiplatelet therapy is recommended for long-term secondary stroke prevention, but discontinuation rates of up to 50% have been reported.

Key results

  • 5.2% of patients with stroke and 7.5% of control patients stopped or interrupted antiplatelet therapy.
  • Patients who interrupted or stopped therapy had higher baseline National Institutes of Health Stroke Scale score (P<.001) and were more likely to have previous ischemic heart disease (P=.004) or stroke (P=.049) compared with persistent users.
  • Risk for cardiovascular event was similar in patients who stopped/interrupted therapy (OR, 0.70; P=.352) or had early cessation (OR, 1.04; P=.876) compared with persistent users.

Study design

  • 194 patients with acute ischemic stroke and 776 matched control patients were analyzed for the effects of stopping/interrupting antiplatelet therapy (used for >3 d, stopped prior to 90 d), early cessation (used for <3 d), and persistent use (used for >3 d, continued up to 90 d).
  • Funding: Ministry of Health, Government of Malaysia Scholarship.

Limitations

  • Lack of information on reasons for discontinuation.
  • Limited study power due to small patient sample size.