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Trends in direct oral anticoagulant use in patients presenting with acute stroke

Kang H Teow1, Peter S Tan2, Tanya Frost2

  • 1Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.

Internal Medicine Journal
|September 13, 2022
PubMed

Insights

Acute ischemic strokes can happen even when taking direct oral anticoagulants (DOACs). This study found DOAC levels were rarely measured or considered during acute stroke treatment, even for eligible patients.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Direct oral anticoagulants (DOACs) are increasingly prescribed for stroke prevention.
  • Despite DOAC use, acute ischemic strokes still occur.
  • Effective acute management strategies for these patients are crucial.

Purpose of the Study:

  • To assess the acute management of stroke presentations in patients prescribed DOACs.
  • To evaluate the utilization of DOAC plasma level assays in acute stroke care.

Main Methods:

  • Retrospective review of stroke patients prescribed DOACs at a primary stroke center.
  • Analysis of patient data over a 3-year period.
  • Assessment of thrombolysis eligibility and DOAC level assay performance.

Main Results:

  • 103 of 195 (52.8%) anticoagulated stroke patients presented within the thrombolysis window.
  • DOAC plasma level assays were performed in only 15 (14.6%) of these eligible patients.
  • Five patients received thrombolysis, with DOAC levels not influencing this decision.

Conclusions:

  • Acute ischemic strokes occur in patients on DOACs.
  • Current acute stroke management protocols may not adequately address DOAC use.
  • Further research is needed to optimize the management of DOAC-treated patients experiencing stroke.

Keywords:
DOAC leveldirect oral anticoagulantischaemicstrokethrombolysis

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