The following is a summary of “Safety and efficacy of intravenous thrombolysis in patients with acute ischemic stroke taking direct oral anticoagulants prior to stroke: a meta-analysis,” published in the June 2023 issue of Neurology by Liang et al.
Researchers performed a retrospective study to assess the safety and efficacy of intravenous thrombolysis (IVT) in subjects with acute ischemic stroke (AIS) taking direct oral anticoagulants (DOACs).
They searched the literature in PubMed, Cochrane Library, and Embase until March 13, 2023. The primary outcome was symptomatic intracranial hemorrhage (sICH). Secondary effects include excellent work (mRS 0–1), functional independence (mRS 0–2), and mortality. Estimated OR with 95% CI using a random-effects model.
The results showed 5 non-randomized studies with 239,879 AIS patients treated with IVT; 3,400 (1.42%) used DOACs before a stroke. Comparing those on DOACs with those without anticoagulants, sICH rates were statistically similar (unadjusted OR 0.98; 95% CI 0.67–1.44; P=0.92; adjusted OR 0.81; 95% CI 0.64–1.03; P=0.09).DOAC patients had higher adjusted rates of excellent outcome (OR 1.22; 95% CI 1.06–1.40; P<0.01) and functional independence (OR 1.25; 95% CI 1.10–1.42; P<0.01) at discharge compared to non-anticoagulant users.No significant difference in mortality or efficacy was found after adjustment.
They concluded this two-line content captures the key findings of the study in a concise and informative way. It also highlights the need for further research to confirm the results.