Assessing Mortality and Safety of IV Thrombolysis in Ischemic Stroke Patients on Direct Oral Anticoagulants (DOACs): A Meta-analysis
Abyaz Asmar1, Arsala Nadeem Khan2, Afia Fatima3, Khadija Alam4, Abdul Haseeb3, Dua Jaffar5, Abdullah Mussarat3, Muhammad Owais Rana6, Hamid Saeed5, Maryam Amir3
1Houston Methodist Neurological Institute, 2Karachi Medical and Dental College, 3Jinnah Sindh Medical College, 4United Medical and Dental College, 5Shaheed Mohtarma Benazir Bhutto Medical College Lyari, 6Dow University of Health Sciences
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.