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Updated: Jun 15, 2025

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Specific Reversal Agents for Direct Oral Anticoagulants in Acute Stroke
Senta Frol1,2, Janja Pretnar Oblak1,2, Mišo Šabovič2,3
1Department of Vascular Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.
Abstract:
Direct oral anticoagulants (DOACs) changed stroke prevention and decreased the risk of ischemic and hemorrhagic complications in patients on oral anticoagulation (OAC) therapy. The numbers of patients prescribed DOACs has increased rapidly. Availability of specific reversal agents opened new avenues in the prevention and management of DOAC complications. An ideal specific reversal agent for a DOAC in acute stroke is an agent which lacks safety concerns and immediately reverses DOAC anticoagulation activity, thereby enabling effective treatment. Reversal of anticoagulant activity is mandatory in patients with acute ischemic stroke (AIS) before performing therapeutic procedures such as intravenous thrombolysis (IVT) and neurosurgery in intracranial hemorrhage (ICH) in order to improve clinical outcomes. In this manuscript we pursue an interdisciplinary approach in discussing advantages and concerns of specific reversal agents in acute stroke DOAC-treated patients in everyday clinical practice.
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