Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke

To the Editor A recent article suggested that the use of non –vitamin K antagonist oral anticoagulants (NOACs) within 7 days of intravenous alteplase was not associated with an increased risk of intracranial hemorrhage. However, we are concerned that some readers may interpret these results as an endorsement of the use of alteplase in patients with acute st roke who were taking NOACs, irrespective of the time frame of last use. Based on dose-finding studies, the drug half-life is 12 hours for apixaban, 11 to 13 hours for rivaroxaban, 10 to 14 hours for edoxaban, and 12 to 17 hours for dabigatran in patients with normal kidney function, meaning that wit hin 48 hours (4 to 5 half-lives), there would be limited residual anticoagulant effect.
Source: JAMA - Category: General Medicine Source Type: research