Background: International guidelines contraindicate intravenous thrombolysis (IVT) in patients with an acute ischaemic stroke (AIS) who have taken a direct oral anticoagulant (DOAC) within 48 hours of presentation. Current pooled data shows that approximately 3% of patients with an AIS are taking a DOAC, but recent observational data suggests patients taking DOACs may not be at increased risk of haemorrhagic complications following IVT.
Aims: We sought to identify the proportion of additional patients who would have been eligible for IVT at our Comprehensive Stroke Centre if they had not been excluded based on recent DOAC ingestion.
Methods: Electronic medical records (EMR) for all patients presenting to our centre with AIS within 4.5 hours of symptom onset were screened retrospectively over 24-months (1/01/2021 to 31/12/2022). The primary outcome was the proportion of patients on a DOAC with no other contraindications for IVT.
Results: There were 569 patients with AIS in the 24-month time-period. Of these, 234/569 (41%) presented within 4.5 hours of symptom onset and 75/234 (32.1%) underwent IVT (mean age 76.1 years, median NIHSS 6). 39/234 (16.7%) had concurrent DOAC ingestion within 48 hours of presentation (17 rivaroxaban, 20 apixaban and 2 dabigatran) and were deemed ineligible for IVT. Additionally, 5/234 (2.1%) were taking warfarin with therapeutic INR. After review of the EMR, 18/234 (7.7% - mean age 76.6 years, median NIHSS 6) patients on a DOAC had no other recorded contraindications to IVT.
Conclusion: At our comprehensive centre, over a 24-month period, we identified an additional 18 (7.7%) AIS patients presenting within 4.5 hours, who could have been considered eligible for IVT had recent ingestion of a DOAC not been treated as a contraindication. Further research is required to determine the safety and efficacy of IVT for AIS patients on a DOAC.