Abstract Details

Title Assessing Mortality and Safety of IV Thrombolysis in Ischemic Stroke Patients on Direct Oral Anticoagulants (DOACs): A Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-002

Objective

To assess the safety of IVT as management of AIS in patients who take DOACs.

Background Intravenous thrombolysis (IVT) is considered a standard reperfusion therapy for acute ischemic stroke (AIS) patients presenting within 4.5 hours of last known well (LKW). Current guidelines contraindicate the use of IVT in patients within the window who are on Direct Oral Anticoagulants (DOACs) and took their last dose within 48 hours of presentation, due to a risk of symptomatic intracranial hemorrhage (sICH).

Design/Methods A thorough literature search of four databases PubMed, Scopus, Medline, Google Scholar, and ScienceDirect was done from inception till 30 May 2023. Double-arm observational studies (retrospective and prospective) that reported outcomes of mortality, sICH, and mRS scores were selected. Results were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and were pooled using a random-effects model.

Results Four eligible studies were included with a total of 238,425 stroke patients who underwent IVT (3,330 in the DOAC arm and 235,217 in the placebo arm). The group with prior DOAC intake showed a significant decrease in sICH development and increase in functional independence at 90 days compared to the control group. No significant association was seen between prior DOAC use and sICH within 36 hours, mortality within three months, or mRS score at three months.

Conclusions The pooled analysis suggests that IVT is a safe management option for acute ischemic stroke in patients with DOAC intake within 2 days prior to symptom onset without an increased risk of serious adverse events.

Authors/Disclosures
Abyaz Asmar, MD PRESENTER	Dr. Asmar has nothing to disclose.
Arsala Khan	No disclosure on file
Afia Fatima	No disclosure on file
Khadija Alam	Khadija Alam has nothing to disclose.
Abdul Haseeb	No disclosure on file
Duaa Jaffar	No disclosure on file
Abdullah Mussarat	No disclosure on file
Muhammad Rana	No disclosure on file
Hamid Saeed	No disclosure on file
Maryam Amir	No disclosure on file

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