Most Read Articles
Pearl Toh, 2 days ago
Every-two-month injections of the long-acting cabotegravir + rilpivirine were noninferior to once-monthly injections for virologic suppression at 48 weeks in people living with HIV*, according to the ATLAS-2M** study presented at CROI 2020 — thus providing a potential option with more convenient dosing.
Stephen Padilla, 19 Mar 2020
The assumption that children are less vulnerable to the coronavirus disease 2019 (COVID-19) compared to adults is not quite true and may even be dangerous, suggests a recent study.
22 Mar 2020
Sustained use of lopinavir-combined regimen appears to confer benefits among patients with the novel coronavirus disease (COVID-19), with improvement possibly indicated by increasing eosinophils, suggests a recent study.
5 days ago
COVID-19 is a novel disease, with no existing immunity. The virus can be transmitted from person to person, quickly and exponentially. Here’s what we can do to slow down the spread, if not contain the outbreak.

IVT safe for stroke patients with prior DOAC exposure

13 Jan 2020

Prior intake of direct oral anticoagulants (DOACs) bears no increased risk of symptomatic intracerebral haemorrhage in acute ischaemic stroke (AIS) patients initiating treatment with intravenous thrombolysis (IVT), according to the results of a meta-analysis.

The meta-analysis included six studies that involved a total of 52,823 AIS patients treated with IVT, among whom 366 had prior exposure to DOACs, 2,133 to warfarin, and 503,241 had no prior anticoagulation. Researchers conducted further analyses according to the following: (1) administration of DOAC within 48 hours vs; (2) consideration of symptomatic intracerebral haemorrhage outcome according to the National Institute of Neurological Disorders (NINDS) vs the European Cooperative Acute Stroke Study II (ECASS-II) criteria.

Pooled data showed no additional risk of symptomatic intracerebral haemorrhage following IVT in patients taking DOACs within 48 hours before the procedure vs those with prior warfarin intake (NINDS: odds ratio [OR], 0.55, 95 percent confidence interval [CI], 0.19–1.59; ECASS-II: OR, 0.77, 95 percent CI, 0.28–2.16) and those without prior anticoagulation (NINDS: OR, 1.23, 95 percent CI, 0.46–3.31; ECASS-II: OR, 0.87, 95 percent CI, 0.32–2.41).

Likewise, there was no risk increase detected in patients who took DOAC at an unknown interval before IVT vs those with prior warfarin intake (NINDS: OR, 0.85, 95 percent CI, 0.49–1.45; ECASS-II: OR, 1.11, 95 percent CI, 0.67–1.85) and those without prior anticoagulation (NINDS: OR, 1.17, 95 percent CI, 0.43–3.15; ECASS-II: OR, 0.87, 95 percent CI, 0.33–2.41).

There was no evidence of heterogeneity across included studies (I2=0 percent).

In an additional analysis of 123 individual cases with or without reversal agents before IVT, no significant increase was noted in the risk of haemorrhagic transformation (OR, 1.48, 95 percent CI, 0.50–4.38), symptomatic haemorrhagic transformation (OR, 0.47, 95 percent CI, 0.09–2.55) or early mortality (OR, 0.60, 95 percent CI, 0.11–3.43) between cohorts who did vs did not receive prethrombolysis idarucizumab.

Editor's Recommendations
Most Read Articles
Pearl Toh, 2 days ago
Every-two-month injections of the long-acting cabotegravir + rilpivirine were noninferior to once-monthly injections for virologic suppression at 48 weeks in people living with HIV*, according to the ATLAS-2M** study presented at CROI 2020 — thus providing a potential option with more convenient dosing.
Stephen Padilla, 19 Mar 2020
The assumption that children are less vulnerable to the coronavirus disease 2019 (COVID-19) compared to adults is not quite true and may even be dangerous, suggests a recent study.
22 Mar 2020
Sustained use of lopinavir-combined regimen appears to confer benefits among patients with the novel coronavirus disease (COVID-19), with improvement possibly indicated by increasing eosinophils, suggests a recent study.
5 days ago
COVID-19 is a novel disease, with no existing immunity. The virus can be transmitted from person to person, quickly and exponentially. Here’s what we can do to slow down the spread, if not contain the outbreak.