Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Recent Direct Oral Anticoagulant Use: A Systematic Review and Meta‐Analysis Article Swipe
Malik Ghannam
,
Mohammad Almajali
,
Milagros Galecio‐Castillo
,
Abdullah M. Al-Qudah
,
Farid Khasiyev
,
Mahmoud Dibas
,
Dana Ghazaleh
,
Juan Vivanco‐Suarez
,
Cristian Morán‐Mariños
,
Mudassir Farooqui
,
Aarón Rodríguez-Calienes
,
Prateeka Koul
,
Hannah Roeder
,
Hyungsub Shim
,
Edgar A. Samaniego
,
Enrique C. Leira
,
Harold P. Adams
,
Santiago Ortega‐Gutiérrez
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1161/jaha.123.031669
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1161/jaha.123.031669
Background Intravenous thrombolysis (IVT) is an effective stroke therapy that remains underused. Currently, the use of IVT in patients with recent direct oral anticoagulant (DOAC) intake is not recommended. In this study we aim to investigate the safety and efficacy of IVT in patients with acute ischemic stroke and recent DOAC use. Methods and Results A systematic review and meta‐analysis of proportions evaluating IVT with recent DOAC use was conducted. Outcomes included symptomatic intracranial hemorrhage, any intracranial hemorrhage, serious systemic bleeding, and 90‐day functional independence (modified Rankin scale score 0–2). Additionally, rates were compared between patients receiving IVT using DOAC and non‐DOAC by a random effect meta‐analysis to calculate pooled odds ratios (OR) for each outcome. Finally, sensitivity analysis for idarucizumab, National Institutes of Health Stroke Scale, and timing of DOAC administration was completed. Fourteen studies with 247 079 patients were included (3610 in DOAC and 243 469 in non‐DOAC). The rates of IVT complications in the DOAC group were 3% (95% CI, 3–4) symptomatic intracranial hemorrhage, 12% (95% CI, 7–19) any ICH, and 0.7% (95%CI, 0–1) serious systemic bleeding, and 90‐day functional independence was achieved in 57% (95% CI, 43–70). The rates of symptomatic intracranial hemorrhage (3.4 versus 3.5%; OR, 0.95 [95% CI, 0.67–1.36]), any intracranial hemorrhage (17.7 versus 17.3%; OR, 1.23 [95% CI, 0.61–2.48]), serious systemic bleeding (0.7 versus 0.6%; OR, 1.27 [95% CI, 0.79–2.02]), and 90‐day modified Rankin scale score 0–2 (46.4 versus 56.8%; OR, 1.21 [95% CI, 0.400–3.67]) did not differ between DOAC and non‐DOAC groups. There was no difference in symptomatic intracranial hemorrhage rate based on idarucizumab administration. Conclusions Patients with acute ischemic stroke treated with IVT in recent DOAC versus non‐DOAC use have similar rates of hemorrhagic complications and functional independence. Further prospective randomized trials are warranted.
Related Topics
Concepts
Medicine
Modified Rankin Scale
Thrombolysis
Stroke (engine)
Odds ratio
Meta-analysis
Intracerebral hemorrhage
Internal medicine
Atrial fibrillation
Intracranial bleeding
Fibrinolytic agent
Ischemic stroke
Tissue plasminogen activator
Subarachnoid hemorrhage
Ischemia
Myocardial infarction
Mechanical engineering
Engineering
Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1161/jaha.123.031669
- OA Status
- gold
- Cited By
- 29
- References
- 51
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4389894575
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4389894575Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1161/jaha.123.031669Digital Object Identifier
- Title
-
Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Recent Direct Oral Anticoagulant Use: A Systematic Review and Meta‐AnalysisWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-12-18Full publication date if available
- Authors
-
Malik Ghannam, Mohammad Almajali, Milagros Galecio‐Castillo, Abdullah M. Al-Qudah, Farid Khasiyev, Mahmoud Dibas, Dana Ghazaleh, Juan Vivanco‐Suarez, Cristian Morán‐Mariños, Mudassir Farooqui, Aarón Rodríguez-Calienes, Prateeka Koul, Hannah Roeder, Hyungsub Shim, Edgar A. Samaniego, Enrique C. Leira, Harold P. Adams, Santiago Ortega‐GutiérrezList of authors in order
- Landing page
-
https://doi.org/10.1161/jaha.123.031669Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://doi.org/10.1161/jaha.123.031669Direct OA link when available
- Concepts
-
Medicine, Modified Rankin Scale, Thrombolysis, Stroke (engine), Odds ratio, Meta-analysis, Intracerebral hemorrhage, Internal medicine, Atrial fibrillation, Intracranial bleeding, Fibrinolytic agent, Ischemic stroke, Tissue plasminogen activator, Subarachnoid hemorrhage, Ischemia, Myocardial infarction, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
29Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 19, 2024: 10Per-year citation counts (last 5 years)
- References (count)
-
51Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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