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Original Article

JAMA Neurology (01/03/23) DOI: 10.1001/jamaneurol.2022.4782

Meinel, Thomas R; Wilson, Duncan; Gensicke, Henrik; et al.

https://jamanetwork.com/journals/jamaneurology/fullarticle/2799622

Summary

An international study of more than 33,000 patients with ischemic stroke found insufficient evidence of excess harm associated with the off-label use of I.V. thrombolysis (IVT) in patients who had recently taken a direct oral anticoagulant (DOAC). Current guidelines recommend the exclusion of patients who have ingested DOACs within the 48 hours previously from receiving IVT after having an ischemic stroke, based on the presumption of a higher risk of symptomatic intracranial hemorrhage (sICH). The retrospective cohort study - conducted at 64 stroke centers across Europe, Asia, Australia, and New Zealand from 2008 through 2021 - compared 832 stroke patients with recent DOAC use with 32,375 stroke patients who had not used DOACs. For patients who had taken DOACs, the unadjusted rate of sICH was 2.5%, compared with 4.1% for those who had not used the drugs. After adjustment, use of DOACs within 48 hours was linked to a lower risk of sICH after IVT compared with no use of DOACs. The authors note "this finding was consistent among the different selection strategies and in sensitivity analyses of patients with detectable plasma levels or very recent ingestion."

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