Purpose(s)
Evidence is lacking regarding acute antithrombotic management in patients with venous thromboembolism (VTE) after stroke (VaS) and hemorrhagic tendency (HT). Our objective was to investigate antithrombotic reversal and resumption strategies by evaluating incidences of hemorrhagic and thromboembolic complications, thereby defining an optimal time-window when to restart therapeutic antithrombotic (TA) in patients with VaS and HT.
Method(s)
We pooled individual patient-data (n=1372) from a single center cohort-study and eventually identified VaS-patients (n=117) with antithrombotic-associated HT for outcome analyses. The primary outcome consisted of major hemorrhagic complications analyzed during hospital stay according to treatment exposure (restarted TA vs. no-TA). Secondary outcomes comprised thromboembolic complications, the composite outcome (hemorrhagic and thromboembolic complications), timing of TA, and mortality. Adjusted analyses involved propensity-score matching and multivariable cox-regressions to identify optimal timing of TA.
Result(s)
Controlling treatment crossovers provided an incidence rate-ratio in disadvantage of TA for hemorrhagic complications. Analyses of TA-timing displayed significant harm until Day 13 after the hazard for the composite—balancing both complications, was increased for restarted TA until Day 6.
Conclusion(s)
Restarting TA within less than 2 weeks after HT in patients with VaS was associated with increased hemorrhagic complications. Optimal weighing—between least risks for thromboembolic and hemorrhagic complications—provided an earliest starting point of TA at Day 6, reserved only for patients at high thromboembolic risk.