Thrombolysis for ischaemic stroke despite direct oral anticoagulation

Stroke Vasc Neurol. 2024 Nov 5;9(5):464-466. doi: 10.1136/svn-2023-002727.

Abstract

Intravenous thrombolysis is not recommended in anticoagulated patients receiving direct oral anticoagulants (DOACs) and a recent intake within the last 48 hours in US and European guidelines. However, three observational studies now suggest safety of thrombolysis in patients with recent intake of DOACs, and thus support previous experimental data. In this perspective, the current evidence and practical consequences are discussed.

Keywords: Anticoagulants; Stroke; Thrombolysis.

MeSH terms

  • Administration, Oral
  • Anticoagulants* / administration & dosage
  • Anticoagulants* / adverse effects
  • Clinical Decision-Making
  • Fibrinolytic Agents* / administration & dosage
  • Fibrinolytic Agents* / adverse effects
  • Hemorrhage / chemically induced
  • Humans
  • Ischemic Stroke* / diagnosis
  • Ischemic Stroke* / drug therapy
  • Ischemic Stroke* / prevention & control
  • Risk Assessment
  • Risk Factors
  • Thrombolytic Therapy* / adverse effects
  • Time Factors
  • Treatment Outcome

Substances

  • Anticoagulants
  • Fibrinolytic Agents