SOP: thrombolysis in ischemic stroke under oral anticoagulation therapy

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Rising rates of atrial fibrillation increase the number of patients on oral anticoagulation for stroke prevention.
• Recurrent ischemic strokes occur in approximately 3% of patients despite adherence to oral anticoagulation therapy.
• Guidelines for intravenous thrombolysis with rt-PA in these patients are often inconsistent or lacking.

Purpose of the Study:

• To provide a standardized operating procedure (SOP) for managing acute ischemic stroke patients on oral anticoagulation therapy.
• To guide clinicians in determining eligibility for rt-PA treatment within the 4.5-hour time window.
• To optimize patient selection for thrombolysis and minimize door-to-needle times.

Main Methods:

• Development of a standardized operating procedure (SOP) based on demographical trends and clinical challenges.
• Consideration of patient-specific factors including type of oral anticoagulant, time since last intake, renal function, and laboratory results.
• Integration of information on the availability of reversal agents for anticoagulation.

Main Results:

• The SOP addresses the critical need for clear recommendations in managing acute stroke patients on oral anticoagulation.
• It facilitates decision-making regarding rt-PA administration in a complex patient population.
• The procedure aims to increase the number of patients who can safely benefit from thrombolytic therapy.

Conclusions:

• Eligibility for rt-PA treatment requires careful consideration of oral anticoagulation type, timing, renal function, and lab results.
• The availability of reversal agents is a key factor in the decision-making process.
• Treatment in a specialized Stroke Unit or Neuro-ICU is recommended for these high-risk patients.