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Recent Use of NOACs and Intracranial Hemorrhage in Patients With Stroke Treated With Alteplase
This retrospective cohort study uses data from hospitals participating in the Get With The Guidelines –Stroke registry on patients with acute ischemic stroke and compares the safety and functional outcomes of intravenous alteplase among patients who were taking non–vitamin K antagonist oral anticoagulants (NOACs) prior to stroke vs patients who were not taking long-term anticoagulants.
Source: JAMA - February 22, 2022 Category: General Medicine Source Type: research

Intravenous thrombolysis in stroke patients taking novel oral anticoagulants: experience with the low-dose 0.6  mg/kg of recombinant tissue-type plasminogen activator. Case reports
In the last decade, the novel oral anticoagulant (NOAC) dabigatran (a direct thrombin inhibitor), rivaroxaban, apixaban and edoxaban (direct factor Xa inhibitors) have been approved for primary and secondary prevention of stroke in patients with atrial fibrillation (AF) [1]. Compared with vitamin k antagonists such as warfarin, the NOACs offer benefits in terms of efficacy, safety and convenience [2]. The only currently approved treatment for acute stroke with a class I recommendation and level A evidence is intravenous recombinant tissue-type plasminogen activator alteplase (IV rt-PA) [4].
Source: Journal of the Neurological Sciences - July 7, 2018 Category: Neurology Authors: Massimiliano Plastino, Domenico Bosco, Laura Giofr è, Dario Cristiano, Franco Galati, Paolo Postorino, Arturo Consoli, Antonietta Fava, Domenico Consoli Tags: Letter to the Editor Source Type: research

Intravenous Thrombolytic Therapy for Treatment of Acute Ischemic Stroke in Patients Taking NOACs
Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (alteplase) is the cornerstone of acute ischemic stroke reperfusion therapy and is associated with significant improvements in outcomes. Historically, a number of exclusion criteria for use of alteplase had been in place, but over the past 20 years, some of these have been eliminated (eg, age>80 years, seizures at stroke onset) or have become less stringent (eg, exclusion criteria may not strictly apply to recent vitamin K antagonist treatment if the patient has an international normalized ratio<1.7, and treatment may be administered in an...
Source: JAMA - February 22, 2022 Category: General Medicine Source Type: research

NOAC Use Not Tied to ICH in Stroke Patients Treated With Alteplase
FRIDAY, Feb. 25, 2022 -- For patients with acute ischemic stroke receiving alteplase, use of non-vitamin K antagonist oral anticoagulants (NOACs) in the previous seven days is not associated with an increased risk for intracranial hemorrhage...
Source: Drugs.com - Pharma News - February 25, 2022 Category: Pharmaceuticals Source Type: news

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