intravenous thrombolysis if ischemic stroke and recent ingestion of DOACs

Last edited 01/2023 and last reviewed 02/2023

A study by Meinel et al investigated whether the recent use of direct oral anticoagulants (confirmed ingestion within 48 hours) associated with increased risk of symptomatic intracranial hemorrhage following intravenous thrombolysis for ischemic stroke

• cohort study including 33207 patients with ischemic stroke who received intravenous thrombolysis at 64 centers in Europe, Asia, Australia, and New Zealand, the risk of symptomatic intracranial hemorrhage was lower among the 832 patients taking direct oral anticoagulant treatment compared with controls with no anticoagulation
  • result was consistent among subgroups and different selection strategies
• study found insufficient evidence of excess harm associated with the use of off-label intravenous thrombolysis in selected patients who had taken a direct oral anticoagulant within the previous 48 hours

Reference:

• Meinel TR, Wilson D, Gensicke H, et al. Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants. JAMA Neurol. Published online January 03, 2023. doi:10.1001/jamaneurol.2022.4782