Building Evidence on Safety of Thrombolysis for Patients Receiving Direct Oral Anticoagulants

Nearly 20% of patients with acute ischemic stroke (AIS) are undergoing direct oral anticoagulant (DOAC) treatment at the time of their stroke. Common indications for DOACs among these patients include stroke prevention from atrial fibrillation, treatment of venous and pulmonary thrombosis, and coronary and peripheral atherosclerotic disease. Novel indications for DOAC use are expected to emerge and may increase the proportion of patients with AIS who are undergoing treatment with DOACs. Current US and European acute stroke treatment guidelines recommend withholding intravenous thrombolysis (thrombolysis), a morbidity- and mortality-saving AIS treatment for patients with recent a DOAC use. DOACs have emerged as preferred anticoagulants over vitamin K antagonists due to a favorable safety profile, particularly a lower risk of severe systemic and intracranial hemorrhage (ICH). However, if this translates into a lower risk of hemorrhagic complications of thrombolysis for AIS in the setting of DOAC treatment is yet to be definitively determined as data supporting this practice are limited and heterogenous. The present study by Meinel et al meaningfully advances the field by generating these critical data. Comparative analyses of different patient selection paradigms for thrombolysis in the presence of DOACs provide additional, timely relevance to the study.
Source: JAMA Neurology - Category: Neurology Source Type: research