The results run counter to current guidelines that recommend against use of IV tissue plasminogen activator (alteplase) in patients who suffer a stroke while on a NOAC, say the authors of the study published in JAMA with simultaneous presentation at the International Stroke Conference.
The author of a JAMA editorial says this study provides "important data" that begins to fill an evidence gap and helps define the safety of IV alteplase among patients taking NOACs.
For their study, Dr. Ying Xian with UT Southwestern Medical Center in Dallas and colleagues identified 163,038 patients with acute ischemic stroke treated with IV alteplase at 1,752 U.S. hospitals participating in the Get With the Guidelines-Stroke registry.
The cohort included 2,207 patients who had taken a NOAC within the previous seven days before stroke onset and alteplase treatment.
The rate of brain hemorrhage was 3.7% among patients taking NOACs compared with 3.2% among patients not taking any anticoagulants, with no statistically significant difference between groups.
There was also no significant between-group difference in the percentage of patients dying in the hospital (6.3% in the NOAC group vs 4.9% in the group not taking any anticoagulants).
In addition, compared to patients not taking anticoagulants, prior use of a NOAC was significantly associated with better adjusted outcomes in terms of patients being discharged home, their ambulatory status, their freedom from disability, and their functional independence at hospital discharge, the authors report.
"To our knowledge, this study represents the largest report on the safety and outcomes of thrombolytic therapy in the setting of recent NOAC use," they write.
In his editorial, Dr. David Seiffge with the Department of Neurology, Inselspital University Hospital and University of Bern, Switzerland, says this study "provides important evidence regarding the use of alteplase among patients with ischemic stroke taking prior NOAC therapy, although the findings to do not provide a definitive answer to the question of safety."
"Future studies are needed to provide more detailed data on patients with recent, verified NOAC intake within 48 hours of alteplase use and to assess the safety profile associated with different patient selection criteria," Dr. Seiffge concludes.
The study had no commercial funding.
SOURCE: https://bit.ly/3LxPUlS and https://bit.ly/3Bfzl9K JAMA, online February 10, 2022.
By Reuters Staff
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