The following is a summary of “Meta-analysis of outcomes following intravenous thrombolysis in patients with ischemic stroke on direct oral anticoagulants,” published in the December 2023 issue of Neurology by Behnoush et al.
Despite previous comparisons, uncertainty surrounds the safety and efficacy of combining recent direct oral anticoagulants (DOACs) use with intravenous thrombolysis (IVT) for ischemic stroke.
Researchers started a retrospective study to systematically analyze whether using DOACs influences the effectiveness and safety of IVT treatment.
They conducted an exhaustive systematic search in PubMed, Embase, Scopus, and the Web of Science to identify relevant studies. Following screening and data extraction, a random-effect meta-analysis was executed to compute the OR and 95% CI for comparing patient outcomes on DOAC and controls. The final review included 6 studies.
The results showed 254,742 patients, with 3,499 having recently used DOACs, mainly rivaroxaban and apixaban. Patients on DOACs exhibited significantly higher rates of atrial fibrillation, hypertension, diabetes, and smoking. The likelihood of an excellent functional outcome (mRS 0–2) was significantly lower in DOAC-receiving patients (OR 0.71, 95% CI 0.62 to 0.81, P<0.01). In the 90-day mRS 0–2 subgroup analysis, no significant difference was found between groups (OR 0.71, 95% 0.46 to 1.11, P=0.14). All-cause mortality did not differ between groups (OR 1.02, 95% CI 0.68 to 1.52, P=0.93), and there was no significant difference in in-hospital and 90-day mortality subgroups. For symptomatic intracranial hemorrhage (sICH), previous DOAC use showed no increased bleeding risk (OR 0.98, 95% CI 0.69 to 1.39, P=0.92). Similar results were found in the meta-analysis of any ICH (OR 1.15, 95% CI 0.94 to 1.40, P=0.18).
They concluded that DOAC use didn’t amplify sICH risk in ischemic stroke patients receiving IVT, offering cautious optimism; more extensive studies needed.
Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03498-8
