2025 Volume 53 Issue 3 Pages 151-159
Background and Purpose: In-hospital ischemic strokes (IHIS) following antithrombotic withdrawal account for more than one-fourth of all IHIS cases. Nevertheless, the characteristics of this stroke type remain poorly understood. This study aimed to investigate the clinical features of IHIS associated with discontinuation of anticoagulant (AC) or antiplatelet (AP) therapy.
Methods: We analyzed 100 patients with IHIS who were consecutively admitted to Osaki Citizen Hospital between January 2015 and July 2020. Patients who were taking or had discontinued antithrombotic therapy at the time of stroke onset were categorized into four groups: AC continuation, AP continuation, AC withdrawal, and AP withdrawal. Clinical features were compared between AC continuation and withdrawal groups and between AP continuation and withdrawal groups.
Results: No significant differences were observed between AC continuation (16 patients) and withdrawal (10 patients) groups. Compared with the AP continuation group (24 patients), the AP withdrawal group (9 patients) had a significantly higher proportion of patients with a history of prior stroke or transient ischemic attack (88.9% vs. 41.7%, p=0.021) and higher median (interquartile range) CHA2DS2-VASc scores (6 [5.8-7] vs. 5 [3.5-6], p=0.006).
Conclusions: These findings indicate that patients who have experienced IHIS after AP withdrawal are at elevated risk of thromboembolism, and many will experience recurrent stroke. A thorough risk assessment of these factors is recommended before AP withdrawal.
