Key result
In stroke patients over 80 years using warfarin, gastrointestinal bleeding was the most common cause of drug discontinuation (41.4%), with antihyperlipidemic drug use as a major risk factor (p=0.001).
Why the study?
Warfarin is only partially preferred for prophylaxis in advanced-age ischemic stroke patients due to potential adverse events and drug interactions.
Cohort (n=189)
In patients over 80 years old with cardioembolic stroke, warfarin is frequently discontinued due to gastrointestinal bleeding, which is significantly associated with concurrent antihyperlipidemic use and irregular hypertension.
Warfarin discontinuation from bleeding is frequent in octogenarian stroke patients; observational data leaves optimal anticoagulation strategies open.
Objective: Warfarin treatment is a partially preferred prophylactic treatment in patients with ischemic stroke with advanced age due to possible adverse events/ drug interactions. In this study, we aimed to investigate the frequency of warfarin use, possible adverse events, and reasons for discontinuation of treatment in patients with stroke aged over 80 years. Materials and Methods: One hundred eighty-nine of 589 patients with stroke were detected retrospectively who were over 80 years and were followed up for cardioembolic stroke between 2014 and 2018. Demographic/clinical/laboratory/radiologic data together with the reasons for discontinuation of the drug were gathered from their medical records and noted in an Excel form. Results: One hundred eighty-nine patients (88 women) were included in the study. The mean duration of warfarin use was noted as 5.023.4 years (minimum 6 months, maximum 11 years). Ninety-four (49.7%) were treated with new oral anticoagulants in the last 2 years due to adverse events and/or social reasons, and 90 (47.6%) were on regular follow-up with warfarin. Gastrointestinal (GIS) bleeding was noted as the most common adverse event causing drug discontinuation (41.4%), and the most important risk factor for GIS symptoms was antihyperlipidemic drug use (p=0.001). Irregular hypertension was the most important risk factor for adverse events due to its triggering impact on bleeding (p<0.001). The mean international normalized ratio (INR) level during intense bleeding was calculated as 3.81.3. Patients with an INR level of 2.5 or higher were more likely to experience other drug-related adverse events (peripheral edema, diarrhea, shortness of breath, headache, dizziness) compared with other INR values (p=0.003). Conclusion: Especially in older stroke patients under antihyperlipidemic treatments, avoiding unnecessary drug use and making sure that the patient reaches required prophylaxis without being dependent on age is crucial.
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Çelik et al. (2020) conducted a cohort in cardioembolic stroke (n=189). Warfarin was evaluated on Frequency of warfarin use, possible adverse events, and reasons for discontinuation. In stroke patients over 80 years using warfarin, gastrointestinal bleeding was the most common cause of drug discontinuation (41.4%), with antihyperlipidemic drug use as a major risk factor (p=0.001).
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