2023
DOI: 10.1001/jamaneurol.2022.4782
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Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants

Abstract: ImportanceInternational guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC).ObjectiveTo determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion.Design, Setting, and ParticipantsThis international, multicenter, retrospective cohort study included 64 primary and comprehensive stroke centers across Europe, Asia, Australia, and New Zeala… Show more

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Cited by 56 publications
(54 citation statements)
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“…Figure 2 outlines the study selection flowchart . A total of 9 studies including 257 389 patients were identified .…”
Section: Resultsmentioning
confidence: 99%
See 3 more Smart Citations
“…Figure 2 outlines the study selection flowchart . A total of 9 studies including 257 389 patients were identified .…”
Section: Resultsmentioning
confidence: 99%
“…A 2022 retrospective cohort study of the US-based Get With the Guidelines–Stroke registry demonstrated that NOAC pretreatment was not associated with a higher risk of ICH after intravenous alteplase treatment for acute ischemic stroke . A 2023 international collaboration retrospective study conducted by Meinel et al reported a similar result. However, the 2 aforementioned studies mainly involved non-Asian patients, with only 3.4% and 20.2% of their populations being individuals of Asian descent.…”
Section: Discussionmentioning
confidence: 99%
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“…In addition, anticoagulation with VKAs precludes the use of intravenous tPA when a patient’s INR is within a therapeutic or supratherapeutic range (ie, an INR of ≥1.7). There is increasing evidence that intravenous tPA may be of appropriately low risk in patients with acute ischemic stroke and recent VKA use with a presenting INR less than 1.7 and in the setting of recent direct oral anticoagulant use . The low risk of sICH associated with tPA use in patients with recent use of VKA and an INR of 1.7 or lower may reflect clinician selection of patients in clinical practice who are otherwise at very low hemorrhagic risk.…”
Section: Discussionmentioning
confidence: 99%