Recent intake of direct oral anticoagulants and acute ischemic stroke: real world data from a comprehensive stroke center Article Swipe

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Doreen Pommeranz , Nicole Lehr , Jordi Kühne Escolà , Bastian Brune , Philipp Dammann , Yan Li , Cornelius Deuschl , Michael Forsting , Clemens Kill , Christoph Kleinschnitz , Martin Köhrmann , Benedikt Frank ·

YOU? · · 2025 · Open Access · · DOI: https://doi.org/10.1186/s42466-025-00438-4

Background Deciding on intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with reported recent direct oral anticoagulant (DOAC) intake remains challenging due to concerns about hemorrhagic risk and the absence of randomized controlled trial evidence. This study aimed to provide a comprehensive characterization of all AIS patients with reported recent DOAC intake—regardless of IVT eligibility—treated at a comprehensive stroke center that routinely measures calibrated anti-facor IIa/Xa activity at admission. Methods In this retrospective study, clinical and procedural data from AIS patients with recent DOAC intake and calibrated anti-factor IIa/Xa activity measured within three hours of admission were analyzed. Patients were treated at the University Hospital Essen between March 2017 and October 2023. Results Among 469 included patients, anti-factor IIa/Xa activity was ≤ 30 ng/ml in 28%, > 30– ≤ 50 ng/ml in 9%, > 50– ≤ 75 ng/ml in 9%, > 75– ≤ 100 ng/ml in 9% and > 100 ng/ml in 45%. Lower DOAC levels correlated with severe stroke symptoms at admission ( ρ = − 0.263, p < 0.001). IVT was administered to 33.5% of patients with DOAC levels ≤ 50 ng/ml, compared to only 4% among those with levels > 50 ng/ml, the majority of whom received prior reversal with idarucizumab. Symptomatic intracranial haemorrhage (sICH) occurred in 4% of IVT-treated and 1% of non-IVT-treated patients, without association to anticoagulation status. Conclusions A considerable proportion of AIS patients with recent DOAC intake exhibited minimal or no anticoagulant activity at presentation. Those with the lowest levels also showed highest stroke severity. IVT was safe across all DOAC level groups, with low and comparable sICH rates. These findings support the rationale for a randomized trial evaluating IVT without prior DOAC level testing.

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Type: article
Language: en
Landing Page: https://doi.org/10.1186/s42466-025-00438-4
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DOI: https://doi.org/10.1186/s42466-025-00438-4

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Title: Recent intake of direct oral anticoagulants and acute ischemic stroke: real world data from a comprehensive stroke center

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Publication year: 2025

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Authors: Doreen Pommeranz, Nicole Lehr, Jordi Kühne Escolà, Bastian Brune, Philipp Dammann, Yan Li, Cornelius Deuschl, Michael Forsting, Clemens Kill, Christoph Kleinschnitz, Martin Köhrmann, Benedikt Frank

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Landing page: https://doi.org/10.1186/s42466-025-00438-4

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abstract_inverted_index.ρ	166
abstract_inverted_index.100	145, 151
abstract_inverted_index.469	116
abstract_inverted_index.9%,	134, 141
abstract_inverted_index.AIS	47, 81, 230
abstract_inverted_index.IVT	55, 173, 254, 278
abstract_inverted_index.all	46, 258
abstract_inverted_index.and	29, 77, 87, 111, 149, 215, 264
abstract_inverted_index.due	23
abstract_inverted_index.for	273
abstract_inverted_index.low	263
abstract_inverted_index.the	30, 104, 197, 246, 271
abstract_inverted_index.was	122, 174, 255
abstract_inverted_index.−	168
abstract_inverted_index.≤	123, 130, 137, 144, 183
abstract_inverted_index.>	128, 135, 142, 150, 194
abstract_inverted_index.<	171
abstract_inverted_index.2017	110
abstract_inverted_index.28%,	127
abstract_inverted_index.45%.	154
abstract_inverted_index.DOAC	52, 85, 156, 181, 234, 259, 281
abstract_inverted_index.This	37
abstract_inverted_index.also	249
abstract_inverted_index.data	79
abstract_inverted_index.from	80
abstract_inverted_index.only	188
abstract_inverted_index.oral	17
abstract_inverted_index.risk	28
abstract_inverted_index.sICH	266
abstract_inverted_index.safe	256
abstract_inverted_index.that	62
abstract_inverted_index.this	73
abstract_inverted_index.were	98, 101
abstract_inverted_index.whom	200
abstract_inverted_index.with	13, 49, 83, 159, 180, 192, 204, 232, 245, 262
abstract_inverted_index.(AIS)	11
abstract_inverted_index.(IVT)	6
abstract_inverted_index.2023.	113
abstract_inverted_index.30–	129
abstract_inverted_index.33.5%	177
abstract_inverted_index.50–	136
abstract_inverted_index.75–	143
abstract_inverted_index.Among	115
abstract_inverted_index.Essen	107
abstract_inverted_index.Lower	155
abstract_inverted_index.March	109
abstract_inverted_index.These	268
abstract_inverted_index.Those	244
abstract_inverted_index.about	26
abstract_inverted_index.acute	8
abstract_inverted_index.aimed	39
abstract_inverted_index.among	190
abstract_inverted_index.hours	95
abstract_inverted_index.level	260, 282
abstract_inverted_index.ng/ml	125, 132, 139, 146, 152
abstract_inverted_index.prior	202, 280
abstract_inverted_index.study	38
abstract_inverted_index.those	191
abstract_inverted_index.three	94
abstract_inverted_index.trial	35, 276
abstract_inverted_index.(DOAC)	19
abstract_inverted_index.(sICH)	209
abstract_inverted_index.0.263,	169
abstract_inverted_index.IIa/Xa	67, 90, 120
abstract_inverted_index.across	257
abstract_inverted_index.center	61
abstract_inverted_index.direct	16
abstract_inverted_index.intake	20, 86, 235
abstract_inverted_index.levels	157, 182, 193, 248
abstract_inverted_index.lowest	247
abstract_inverted_index.ng/ml,	185, 196
abstract_inverted_index.rates.	267
abstract_inverted_index.recent	15, 51, 84, 233
abstract_inverted_index.severe	160
abstract_inverted_index.showed	250
abstract_inverted_index.stroke	10, 60, 161, 252
abstract_inverted_index.study,	75
abstract_inverted_index.within	93
abstract_inverted_index.0.001).	172
abstract_inverted_index.Methods	71
abstract_inverted_index.October	112
abstract_inverted_index.Results	114
abstract_inverted_index.absence	31
abstract_inverted_index.between	108
abstract_inverted_index.groups,	261
abstract_inverted_index.highest	251
abstract_inverted_index.minimal	237
abstract_inverted_index.provide	41
abstract_inverted_index.remains	21
abstract_inverted_index.status.	224
abstract_inverted_index.support	270
abstract_inverted_index.treated	102
abstract_inverted_index.without	220, 279
abstract_inverted_index.Abstract	0
abstract_inverted_index.Deciding	2
abstract_inverted_index.Hospital	106
abstract_inverted_index.Patients	100
abstract_inverted_index.activity	68, 91, 121, 241
abstract_inverted_index.clinical	76
abstract_inverted_index.compared	186
abstract_inverted_index.concerns	25
abstract_inverted_index.findings	269
abstract_inverted_index.included	117
abstract_inverted_index.ischemic	9
abstract_inverted_index.majority	198
abstract_inverted_index.measured	92
abstract_inverted_index.measures	64
abstract_inverted_index.occurred	210
abstract_inverted_index.patients	12, 48, 82, 179, 231
abstract_inverted_index.received	201
abstract_inverted_index.reported	14, 50
abstract_inverted_index.reversal	203
abstract_inverted_index.symptoms	162
abstract_inverted_index.testing.	283
abstract_inverted_index.admission	97, 164
abstract_inverted_index.analyzed.	99
abstract_inverted_index.evidence.	36
abstract_inverted_index.exhibited	236
abstract_inverted_index.patients,	118, 219
abstract_inverted_index.rationale	272
abstract_inverted_index.routinely	63
abstract_inverted_index.severity.	253
abstract_inverted_index.Background	1
abstract_inverted_index.University	105
abstract_inverted_index.admission.	70
abstract_inverted_index.anti-facor	66
abstract_inverted_index.calibrated	65, 88
abstract_inverted_index.comparable	265
abstract_inverted_index.controlled	34
abstract_inverted_index.correlated	158
abstract_inverted_index.evaluating	277
abstract_inverted_index.procedural	78
abstract_inverted_index.proportion	228
abstract_inverted_index.randomized	33, 275
abstract_inverted_index.Conclusions	225
abstract_inverted_index.IVT-treated	214
abstract_inverted_index.Symptomatic	206
abstract_inverted_index.anti-factor	89, 119
abstract_inverted_index.association	221
abstract_inverted_index.challenging	22
abstract_inverted_index.haemorrhage	208
abstract_inverted_index.hemorrhagic	27
abstract_inverted_index.intravenous	4
abstract_inverted_index.administered	175
abstract_inverted_index.considerable	227
abstract_inverted_index.intracranial	207
abstract_inverted_index.thrombolysis	5
abstract_inverted_index.anticoagulant	18, 240
abstract_inverted_index.comprehensive	43, 59
abstract_inverted_index.idarucizumab.	205
abstract_inverted_index.presentation.	243
abstract_inverted_index.retrospective	74
abstract_inverted_index.anticoagulation	223
abstract_inverted_index.non-IVT-treated	218
abstract_inverted_index.characterization	44
abstract_inverted_index.intake—regardless	53
abstract_inverted_index.eligibility—treated	56
cited_by_percentile_year
corresponding_author_ids	https://openalex.org/A5093252889
countries_distinct_count	1
institutions_distinct_count	12
citation_normalized_percentile