January 3, 2023
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Meinel reports receiving a grant from the Bangerter Reiner Foundation while conducting this research. See research for relevant financial disclosures of all other authors. Mistry reports that he has received grants from the National Institute of Neurological Disorders and Stroke and is a consultant for RAPID AI.
Evidence of excess harm associated with off-label IV thrombolysis in postischemic stroke patients who have recently taken direct oral anticoagulants was inadequate, the investigators report. JAMA Neurology.
International guidance now recommends avoiding IV thrombolysis in ischemic stroke patients who have recently taken direct oral anticoagulants. Thomas R. Meinel, MD, Written by researchers from the Center for Stroke Research at the University of Bern in Switzerland.
Meinel et al. sought to determine whether the risk of symptomatic intracranial hemorrhage was associated with IV thrombolysis in patients who had recently taken oral anticoagulants.
Researchers conducted an international, multicenter, retrospective cohort study that included 64 stroke centers in Asia, Australia, Europe, and New Zealand. Adult patients with ischemic stroke who received IV thrombolysis were included. Patients who had taken direct oral anticoagulants more than 48 hours before her stroke onset were excluded.
A total of 832 patients who recently received direct oral anticoagulants were compared with 32,375 controls. Of the 33,207 patients, 14,458 (43.5%) were female, with a median age of her 73 years.
Of the 832 patients taking direct oral anticoagulants, 252 (30.3%) underwent direct oral anticoagulant reversal prior to IV thrombolysis. Oral anticoagulant levels were measured directly in 225 (27%). 355 (42.7%) received IV thrombolysis without direct measurement of oral anticoagulant plasma levels and without inverse treatment.
The unadjusted incidence of symptomatic intracranial hemorrhage was 4.1% (95% CI, 3.9–4.4) in controls not receiving direct oral anticoagulants compared with 4.1% (95% CI, 3.9–4.4) in those receiving direct oral anticoagulants. 2.5% (95% CI, 1.6–3.8) in patients with
Furthermore, recent use of direct oral anticoagulants was associated with lower odds of symptomatic intracranial hemorrhage after IV thrombolysis compared with no anticoagulants (adjusted OR = 0.57; 95% CI 0.36-0.92).
“We found insufficient evidence of excess harm associated with [IV thrombolysis] in selected patients with recent ischemic stroke [direct oral anticoagulant] Meiner and colleagues wrote. “This is true regardless of the strategy chosen and may be consistent with the net income of [IV thrombolysis] in those patients.
In a related editorial, Eva A. Mistry, MBBS, MSCI, A professor of Neurology and Rehabilitation Medicine at the University of Cincinnati noted that nearly 20% of patients with acute ischemic stroke receive direct oral anticoagulant therapy at the time of stroke.
Mistry said Meinel and colleagues’ study “provides time-critical preliminary data on thrombolysis in patients.” [acute ischemic stroke] Recent [direct oral anticoagulant] use. In addition, although limited, the data provided by the study may be used by clinicians to make individualized decisions about thrombolysis in patients who have recently used direct oral anticoagulants, Mistry said. I’m here.
Mistry EA. JAMA Neurology. 2023; doi:10.1001/jamaneurol.2022.4765.