Intravenous thrombolysis safe, beneficial for stroke patients with recent DOAC use

In the treatment of acute ischaemic stroke in patients with recent direct oral anticoagulant (DOAC) use, intravenous thrombolysis appears to be safe and is associated with improvements in functional outcomes, according to a study.

Researchers used data from the Get With The Guidelines registry and identified patients with a diagnosis of acute ischaemic stroke within 4.5 h from last known normal, on a DOAC, and either (1) received intravenous thrombolysis, or (2) were excluded from thrombolysis with coagulopathy being the only reason for exclusion.

The analysis included a total of 48,907 patients (mean age 75.1 years, 50.5 percent male) with acute ischaemic stroke who were using a DOAC, of whom 4,702 received thrombolysis and 44,205 did not.

The primary outcomes were ambulatory status at discharge and discharge disposition. Good outcomes were defined as independent ambulation at discharge and discharge to home. Safety outcomes included symptomatic intracranial haemorrhage, serious systemic haemorrhage, and in‐hospital death or discharge to hospice. 

Adjusted logistic regression models showed that patients with recent DOAC use who did vs did not receive intravenous thrombolysis had more than 30-percent greater odds of independent ambulation at discharge (odds ratio [OR], 1.35, 95 percent confidence interval [CI], 1.21–1.50) and home discharge (OR, 1.33, 95 percent CI, 1.22–1.46).

Among patients who received intravenous thrombolysis, the proportions of those who had symptomatic intracranial haemorrhage and systemic haemorrhage were 3.5 percent and 0.5 percent, respectively. In binary logistic regression analysis, a higher NIHSS score emerged as the sole risk factor for symptomatic intracranial haemorrhage (adjusted OR, 1.05 per point, 95 percent CI, 1.04–1.07; p<0.001).

Moreover, intravenous thrombolysis was associated with 30-percent lower risk of in‐hospital death or discharge to hospice (adjusted OR, 0.70, 95 percent CI, 0.62–0.80).