Warfarin in patients with stroke and reasons for discontinuation.

Background: Reasons for warfarin prescription in patients who have had ischemic stroke, and its discontinuation, are complex and unique for each individual patient.

Objective: We sought to discover the reasons for discontinuation of warfarin therapy in patients followed up in a medical center antithrombosis clinic after stroke occurrence.

Materials: In all, 229 patients on warfarin therapy with history of stroke were followed up in our antithrombosis clinic between January 1997 and March 2003. Of these patients, 132 were identified as having left the medical center antithrombosis clinic. Reasons for discontinuation of therapy were noted. Patients on combination antiplatelet-warfarin therapy were identified, as were the reasons for antithrombotic therapy.

Results: The most common reason for discontinuation of warfarin was noncompliance with therapy and failure to show up for scheduled visits to the antithrombosis clinic. Hemorrhage was rare and not solely attributed to anticoagulation alone. The complication rate for major hemorrhage was 2.18%, well within the accepted range for US antithrombosis clinics. This rate included those on combination antiplatelet-anticoagulant therapy.

Conclusions: Combination therapy of warfarin and antiplatelet agents may not be dangerous in this group of patients. Careful assessment of patients on warfarin therapy in a medical center-based antithrombosis clinic assures close supervision of compliance, potential complications, and general medical and environmental conditions of the patient and allows for a controlled discontinuation of anticoagulation if necessary.