The AAN's new "Evidence-based Guideline: Periprocedural Management of Antithrombotic Medications in Patients with Ischemic Cerebrovascular Disease," published in the May 28, 2013, issue of Neurology ®, recommends that people who take antithrombotic medications for stroke should work closely with their physicians or medical care teams to determine whether these medications should be continued to maintain stroke prevention efforts or temporarily stopped to lower the risk of bleeding with the procedure.
“There may be millions of Americans taking antithrombotic medications for stroke prevention. For every dental procedure, minor medical procedure, or surgery these people plan to have, it is important to balance stroke risk from stopping an antithrombotic agent with a procedure’s bleeding risk if the medication is continued,” said lead author Melissa Armstrong, MD. “This guideline helps patients and physcians know what evidence tells us about these different risks. A person’s health history and preferred course of action are also important to discuss when making this decision,” Armstrong added.
The available evidence varies from medication to medication and procedure to procedure. However, the bleeding risks for aspirin use are clearer than the risks for other antithrombotics. For certain minor procedures, particularly dental ones, the evidence shows that antithrombotics should not be stopped in most stroke patients who are undergoing these procedures. Some common practices such as heparin bridging have little evidence either to support or to refute their use.
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