Abstract | BACKGROUND: OBJECTIVE: Systematic literature review to provide a comprehensive clinical overview in terms of presentation, laboratory, imaging parameters and outcomes of patients suffering from acute cerebral ischemic events (i.e. TIA and acute ischemic stroke) while on treatment with a NOAC. Only if available, comparison to VKA is presented which was not the primary focus of this analysis. DATA SOURCES: PubMed/MEDLINE, Scopus and EMBASE from January 1, 2006, to November 20, 2018. STUDY ELIGIBILITY CRITERIA: 52 studies providing detailed information on a total of 12247 patients were included. We excluded case reports and case series with less than five patients. STUDY APPRAISAL AND SYNTHESIS METHOD: We systematically assessed study quality using a bias tool and pooled consistent data. RESULTS: Existing data indicates milder stroke severity and smaller infarct size of acute ischemic stroke on treatment with NOAC compared to stroke occurrence on Vitamin K antagonists (VKA). Established risk factors for ischemic events also play a role in stroke while on NOACs, albeit the underlying etiology remains poorly understood. Intravenous thrombolysis and endovascular therapy seem to be safe and effective, but patient selection for recanalization therapies is challenging. LIMITATIONS: Limited quality of published data, duplicate cases, statistical issues of data pooling, possible incomplete retrieval of identified research and reporting bias might have limited our findings. CONCLUSIONS: Acute ischemic events despite treatment with NOAC therapy are insufficiently investigated. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO: CRD42018074853.
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Authors | Thomas Raphael Meinel, Sebastién Frey, Marcel Arnold, Sarah Kendroud, Urs Fischer, Johannes Kaesmacher, Mirjam Rachel Heldner, Simon Jung |
Journal | PloS one
(PLoS One)
Vol. 14
Issue 3
Pg. e0213379
( 2019)
ISSN: 1932-6203 [Electronic] United States |
PMID | 30925155
(Publication Type: Journal Article, Systematic Review)
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Chemical References |
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Topics |
- Administration, Oral
- Anticoagulants
(administration & dosage, adverse effects, therapeutic use)
- Atrial Fibrillation
(complications, drug therapy)
- Brain Ischemia
(diagnosis, etiology, therapy)
- Endovascular Procedures
- Female
- Humans
- Ischemic Attack, Transient
(diagnosis, etiology, therapy)
- Male
- Reperfusion
- Risk Factors
- Stroke
(diagnosis, etiology, therapy)
- Thrombolytic Therapy
- Vitamin K
(antagonists & inhibitors)
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