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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 k...
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research

Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke —Reply
In Reply We agree that conclusions drawn from our observational cohort study should be interpreted within the context of the study design and its inherent limitations. One such limitation is the lack of granular data on the time of last NOAC dose. The GWTG-Stroke registry defines NOAC use as documentation that a patient was taking dabigatran, rivaroxaban, apixaban, or edoxaban within 7 days before hospital arrival. We attempted to overcome this limitation by including additional data from the ARAMIS registry.
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research

Oral Anticoagulants and the Risk of Intracranial Hemorrhage
Conclusions and Relevance Novel oral anticoagulants are uniformly associated with an overall reduced risk of ICH when used for stroke prevention in atrial fibrillation. Any of the currently available NOACs can be considered first line for patients at high risk for ICH.JAMA Neurol. 2013;70(12):1486-1490. doi:10.1001/jamaneurol.2013.4021.
Source: JAMA - December 17, 2014 Category: Journals (General) Source Type: research