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.
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Authors | Shima Shahjouei, Georgios Tsivgoulis, Reza Bavarsad Shahripour, G Morgan Jones, Andrei V Alexandrov, Ramin Zand |
Journal | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
(J Stroke Cerebrovasc Dis)
Vol. 24
Issue 12
Pg. 2685-93
(Dec 2015)
ISSN: 1532-8511 [Electronic] United States |
PMID | 26542821
(Publication Type: Case Reports, Journal Article, Review, Systematic Review)
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Copyright | Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Anticoagulants
- Fibrinolytic Agents
- Tissue Plasminogen Activator
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Topics |
- Aged
- Aged, 80 and over
- Anticoagulants
(therapeutic use)
- Brain Ischemia
(drug therapy)
- Female
- Fibrinolytic Agents
(adverse effects, therapeutic use)
- Humans
- Male
- Middle Aged
- Stroke
(drug therapy)
- Thrombolytic Therapy
(adverse effects)
- Tissue Plasminogen Activator
(adverse effects, therapeutic use)
- Treatment Outcome
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