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Safety of Intravenous Thrombolysis Among Stroke Patients Taking New Oral Anticoagulants - Case Series and Systematic Review of Reported Cases Publisher Pubmed



Shahjouei S1 ; Tsivgoulis G2, 3, 4 ; Bavarsad Shahripour R5 ; Jones GM6 ; Alexandrov AV2 ; Zand R2
Authors
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Authors Affiliations
  1. 1. Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Neurology, University of Tennessee, Health Sciences Center, 855 Monroe Ave, Memphis, 38163, TN, United States
  3. 3. Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
  4. 4. International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic
  5. 5. Department of Neurology, University of Alabama, Birmingham, AL, United States
  6. 6. College of Pharmacy, University of Tennessee, Health Sciences Center, Memphis, TN, United States

Source: Journal of Stroke and Cerebrovascular Diseases Published:2015


Abstract

Background Current guidelines do not recommend the administration of intravenous tissue plasminogen activator (IV-tPA) to patients with acute ischemic stroke (AIS) who take new oral anticoagulants (NOACs). We present a multicenter case series of IV-tPA use while the patients are on NOACs, as well as a systematic review of the literature. Methods We reviewed the medical records of consecutive patients on NOACs who received IV-tPA for symptoms of AIS at four participating stroke centers in the United States and Europe. Safety endpoints were post-thrombolysis symptomatic intracranial hemorrhage (sICH) or other serious systemic bleeding. Results Between October 2010 and October 2014, 6 patients received IV-tPA for possible AIS while taking dabigatran. None of the patients had sICH or any other hemorrhagic complication. Literature review resulted in a total of 26 patients receiving IV-tPA while on NOACs (dabigatran: 15, rivaroxaban: 10, apixaban: 1). Among them, two patients experienced sICH and died. None of the patients experienced major extracranial hemorrhage; however, minor and asymptomatic hemorrhagic complications were described in 7 patients. Pooled analysis indicates an sICH rate of 6.45% (95% CI by the adjusted Wald method:.8-21.7%). The mean interval between the last dose of NOAC and IV thrombolysis was 12 ± 7.8 [4-28.3] hours. Conclusions Although the safety of IV-tPA cannot be definitively confirmed in a small series, consideration of stroke severity and management of hemorrhage risk with general precautions with post-tPA management protocols can justify treatment in the absence of coagulopathy. © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
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