IV Thrombolysis for Acute Ischemic Stroke with Unknown Onset in Patients on Oral Anticoagulation
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View abstract on PubMed
Summary
This summary is machine-generated.Intravenous thrombolysis (IVT) for ischemic stroke is safe in selected patients on oral anticoagulation, including direct oral anticoagulants (DOACs) and vitamin-K antagonists (VKAs), even with an unknown onset time.
Area Of Science
- Neurology
- Cardiology
- Radiology
Background
- Intravenous thrombolysis (IVT) is a standard treatment for acute ischemic stroke, particularly in extended or unknown time windows, often guided by multimodal imaging.
- Evidence supports IVT in patients taking oral anticoagulants, including direct oral anticoagulants (DOACs).
- However, data on IVT for ischemic stroke patients on oral anticoagulation with an unknown onset time are limited.
Purpose Of The Study
- To evaluate the safety and efficacy of IVT in ischemic stroke patients on oral anticoagulation with an unknown time of stroke onset.
- To compare the incidence of intracranial hemorrhage (ICH) in patients on oral anticoagulation versus those not on anticoagulation.
Main Methods
- A longitudinal cohort study (STAMINA) included acute ischemic stroke patients treated with IVT in an unknown or extended time window (January 2015 - December 2019).
- Patient selection was based on multimodal CT or MRI.
- Patients on oral anticoagulation (VKA or DOAC within 48h) were eligible if INR or plasma levels met institutional criteria. Primary outcomes were any and symptomatic intracranial hemorrhage (ICH).
Main Results
- Of 170 patients receiving IVT in the unknown/extended window, 19 were on oral anticoagulation (6 VKA, 13 DOAC).
- The risk of symptomatic ICH was similar between patients with and without oral anticoagulation (5.3% vs. 2.7%, p=0.453).
- Oral anticoagulation was not significantly associated with symptomatic ICH after adjusting for confounders (aOR 1.02 [0.09-11.02], p=0.988).
Conclusions
- IVT for ischemic stroke with an unknown onset time appears safe in carefully selected patients on oral anticoagulation.
- This includes patients treated with both DOACs and VKAs.
- Further research may confirm these findings in larger cohorts.
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