Tuesday, May 28, 2013
University of Maryland Physician Leads Development of New Guidelines from the American Academy of Neurology
People taking blood thinning medicines, such as aspirin or warfarin, to prevent stroke may have an increased bleeding risk during medical procedures. However, if patients who have had a previous stroke stop these drugs prior to a particular procedure, they may increase their risk for another stroke.
This dilemma prompted researchers from the
“Our analysis found that the risk of bleeding varies depending on the procedure,” explains lead guideline author Melissa Armstrong, MD, assistant professor of neurology at the University of Maryland School of Medicine. “For many minor procedures, such as dental procedures, the increased bleeding risk with these medications is low. However, for certain larger procedures, such as hip and colon procedures, the anti-clotting therapies may increase the risk of bleeding during the procedure.”
“This guideline helps doctors and patients know what the evidence tells us about these different risks, so they can weigh an individual’s health history when deciding whether it is necessary to stop the anti-clotting therapies,” adds Dr Armstrong, who is also a neurologist at the University of Maryland Medical Center.
According to the researchers, millions of Americans may be on these anti-clotting drugs to prevent stroke. These medications are also used to prevent a first stroke in people with atrial fibrillation, an irregular or fast heartbeat. The guideline did not review evidence for people with heart problems other than atrial fibrillation.
The panel of neurologists did an extensive review of scientific studies for the analysis. However, they found most of the research on bleeding risk with these drugs looked at aspirin and warfarin.
“More studies are needed to understand the bleeding risks associated with other blood thinners during and before procedures. These other medications include clopidogrel and aspirin plus dipyridamole, as well as new anticoagulants such as dabigatran, rivaroxaban, or apixaban,” explains Dr. Armstrong.
The analysis found strong evidence that aspirin and warfarin do not increase important bleeding risks during dental procedures and moderate evidence that they do not increase important bleeding risks during dermatological (skin) procedures. Other minor procedures ranging from some eye surgeries to epidural procedures are probably also safe while continuing these drugs, particularly for patients taking aspirin. The researchers found few studies to guide decisions regarding more invasive procedures. They emphasize that all this evidence needs to be balanced with each patient's individual circumstances.
“These new guidelines show the commitment of our University of Maryland School of Medicine faculty to seek out, analyze and apply sound evidence to inform complex medical care. This information will enable clinicians to make the best decisions for their patients who are at risk of a stroke, one of the leading causes of death and disability in the United States,” says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the
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