WSC 2025 | Specific scenarios where intravenous thrombolysis is safe for ischemic stroke patients on DOACs
Thorsten Steiner, MD, PhD, Frankfurt & Heidelberg University, Heidelberg, Germany, discusses specific scenarios where intravenous thrombolysis may be safe for the treatment of ischemic stroke in patients who are taking direct oral anticoagulants (DOACs). Prof. Steiner highlights that idarucizumab can be used to reverse the effects of dabigatran before thrombolysis. This interview took place at the 17th World Stroke Congress (WSC) in Barcelona, Spain.
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Transcript
In general, I would say we should avoid it. In general, there may be some situations, for example, if a patient is on dabigatran, there are reasonable reports and yes, there are reports and observational studies that show that it is safe to use idarucizumab in these patients to reverse the effect of, in this case, dabigatran and then perform thrombolysis. The reason why I think this might be an exception is because it makes a lot of sense pathophysiologically wise to reverse the effect of dabigatran because idarucizumab is such a specific reversal agent...
In general, I would say we should avoid it. In general, there may be some situations, for example, if a patient is on dabigatran, there are reasonable reports and yes, there are reports and observational studies that show that it is safe to use idarucizumab in these patients to reverse the effect of, in this case, dabigatran and then perform thrombolysis. The reason why I think this might be an exception is because it makes a lot of sense pathophysiologically wise to reverse the effect of dabigatran because idarucizumab is such a specific reversal agent. While when you use other reversal agents, they affect the coagulation system in general. And so you have no clue what might happen. And for example, whether it might be also associated with an increased risk of thrombotic effects.
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Disclosures
Honoray fees and/or honoraria from: AstraZeneca, Bayer, BMS Pfizer, Boehringer, Chiesi.
