Antiplatelet drug discontinuation is a risk factor for ischemic stroke
Abstract
Antiplatelet drugs (APD) are widely used in the prevention of ischemic cardio- and cerebrovascular diseases. The authors studied the frequency of stroke occurring after APD discontinuation, the cause of discontinuation, and the delay between APD disruption and stroke. Only 4.49% of strokes were related to a recent APD discontinuation, but all cases occurred between 6 and 10 days after drug discontinuation (p < 0.0001). This temporal pattern has biologic plausibility because the inhibited platelets circulate in the blood for about 10 days.
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Publication History
Received: August 25, 2003
Accepted: November 26, 2003
Published online: April 12, 2004
Published in issue: April 13, 2004
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We thank Dr Bachman for calling our attention to his letter on antiplatelet drug disruption . [1] We did not reference this in our discussion but failed to identify it in our literature review. However, we believe that defining its content as "virtually the same information" is an overstatement.
The letter by Dr Bachman anecdotally describes 13 cases, not systematically screened, from an undefined population of ischemic strokes. The delay between aspirin discontinuation and the associated ischemic strokes, which is the key point of our paper [2] is not specified in three cases and was two weeks or more in seven cases. So we suspect that, in this series, a majority of cases may not be related to the aspirin discontinuation.
References
1). Bachman DS. Discontinuing chronic aspirin therapy: another risk factor for stroke? Ann Neurol. 2002;51:137-8.
2). Sibon I, Orgogozo JM. Antiplatelet drug discontinuation is a risk factor for ischemic stroke. Neurology. 2004 13;62:1187-1189.
Regarding the recent paper reporting the risk of stopping antiplatelet drugs [1], I reported virtually the same information in the Annals in 2001, including a Title and a Table of cases which are quite similar to the current publication. [2].
References
1) Sibon I and Orgogozo J. Antiplatelet drug discontinuation is a risk factor for ischemic stroke Neurology 2004; 62: 1187-1189.
2) Bachman D. Discontinuing Chronic Aspirin Therapy: Another risk factor for stroke? Ann Neurol 2002; 51:137-138.