(HealthDay News) – For patients with ischemic cerebrovascular disease taking antithrombotic drugs, the risk of bleeding varies for different medical procedures, which should guide discontinuation decisions, according to a guideline from the American Academy of Neurology (AAN), published in the May 28 issue of Neurology.
Melissa J. Armstrong, MD, from the University of Maryland School of Medicine in Baltimore, and colleagues from the Guideline Development Subcommittee of the AAN conducted a systematic literature review to develop evidence-based guidelines for periprocedural management of patients with a history of ischemic cerebrovascular disease receiving anticoagulation or antiplatelet agents.
According to the report, stroke patients should routinely continue aspirin and warfarin (Level A) when undergoing dental procedures and should probably continue aspirin (Level B) when undergoing cataract surgery, dermatologic procedures, transrectal ultrasound-guided prostate biopsy, spinal/epidural procedures, and carpal tunnel surgery. Aspirin should possibly be continued (Level C) for patients undergoing vitreoretinal surgery, electromyography, transbronchial lung biopsy, colonoscopic polypectomy, upper endoscopy and biopsy/sphincterotomy, and abdominal ultrasound-guided biopsies. Warfarin should probably be continued for dermatological procedures (Level B), and its use probably does not increase clinically important bleeding with ocular anesthesia (Level B). Warfarin might increase bleeding with colonoscopic polypectomy (Level C), and some patients undergoing electromyography, prostate procedures, inguinal herniography, and endothermal ablation of the great saphenous vein should possibly continue warfarin (Level C). Compared with warfarin cessation, bridging therapy is possibly associated with increased bleeding risks (Level B).
“Clinicians managing antithrombotic medications periprocedurally must weigh bleeding risks from drug continuation against thromboembolic risks from discontinuation,” the authors write.
Two authors disclosed financial ties to UpToDate.com; one author disclosed financial ties to the pharmaceutical industry.