Effect of warfarin withdrawal on thrombolytic treatment in patients with ischaemic stroke.
Summary of "Effect of warfarin withdrawal on thrombolytic treatment in patients with ischaemic stroke."
Background and purpose:  Abruptly discontinuing warfarin may induce a rebound prothrombotic state. Thrombolytic agents may also paradoxically induce prothrombotic conditions, which include platelet activation and thrombin generation. Therefore, prothrombotic states may be enhanced by withdrawing warfarin in patients under thrombolytic treatment. This study was aimed to determine whether patients with warfarin withdrawal have different clinical outcomes from those without warfarin use after thrombolytic treatment. Methods:  A total of 148 consecutive patients with atrial fibrillation who were not on anticoagulants at admission and who received thrombolysis were included in this study. We compared the outcomes between a warfarin withdrawal group and a no-warfarin group. Results:  Fourteen patients (9.5%) were included in the warfarin withdrawal group. Although baseline National Institute of Health Stroke Scale (NIHSS) scores, recanalization rates, and hemorrhage frequencies did not differ between the groups, the warfarin withdrawal group showed poorer outcomes. Increased NIHSS scores during the first 7 days were more frequent in the warfarin withdrawal group (57.1% vs. 26.9%, P = 0.029). The median percent improvement in NIHSS scores at 24 h after thrombolysis was also lower in the warfarin withdrawal group. After adjusting for covariates, warfarin withdrawal was a strong predictor of poor functional outcome at 3 months (modified Rankin score ≥ 3) (odds ratio, 17.067, 95% CI 2.703-107.748). Conclusions:  Discontinuing warfarin was associated with early neurologic deterioration and poor long-term outcomes after thrombolytic treatment.
Affiliation
Department of Neurology, Severance Hospital Integrative Research Institute for Cerebral and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
Journal Details
This article was published in the following journal.
Name: European journal of neurology : the official journal of the European Federation of Neurological Societies
ISSN: 1468-1331
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21314856
- DOI: http://dx.doi.org/10.1111/j.1468-1331.2011.03363.x
Medical and Biotech [MESH] Definitions
Warfarin
An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide.
Substance Withdrawal Syndrome
Physiological and psychological symptoms associated with withdrawal from the use of a drug after prolonged administration or habituation. The concept includes withdrawal from smoking or drinking, as well as withdrawal from an administered drug.
Withholding Treatment
Withholding or withdrawal of a particular treatment or treatments, often (but not necessarily) life-prolonging treatment, from a patient or from a research subject as part of a research protocol. The concept is differentiated from REFUSAL TO TREAT, where the emphasis is on the health professional's or health facility's refusal to treat a patient or group of patients when the patient or the patient's representative requests treatment. Withholding of life-prolonging treatment is usually indexed only with EUTHANASIA, PASSIVE, unless the distinction between withholding and withdrawing treatment, or the issue of withholding palliative rather than curative treatment, is discussed.
Enprostil
A synthetic PGE2 analog that has an inhibitory effect on gastric acid secretion, a mucoprotective effect, and a postprandial lowering effect on gastrin. It has been shown to be efficient and safe in the treatment of gastroduodenal ulcers.
Oxazepam
A benzodiazepine used in the treatment of anxiety, alcohol withdrawal, and insomnia.
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