ESOC 2024 | Study of intravenous thrombolysis in patients with recent intake of direct oral anticoagulants

Philipp Bücke, MD, MSc, University Hospital Bern, Bern, Switzerland, discusses intravenous thrombolysis (IVT) in patients with ischemic stroke and recent ingestion of direct oral anticoagulants (DOACs). Current guidelines recommend the exclusion of patients with DOAC intake within the last 48 hours from receiving IVT, based on the increased risk of symptomatic intracranial hemorrhage (sICH). However, there is a lack of data to support this presumption. When early evidence indicated there may be a benefit to IVT in these patients, the team in Bern sequentially liberalized their own institutional guidelines to allow patients to receive IVT regardless of DOAC plasma levels or time of last intake. When comparing patients with recent DOAC intake who received IVT versus those who did not, no safety concerns were identified and patients receiving IVT were more likely to have good functional outcomes. As 1 in 6 patients with stroke otherwise qualifying for IVT has a prescription for DOACs, this finding warrants further investigation. This interview took place at the 10th European Stroke Organisation Conference (ESOC) 2024 in Basel, Switzerland.

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