ReviewJournal of neurology, neurosurgery, and psychiatry2021
Recanalisation therapies for acute ischaemic stroke in patients on direct oral anticoagulants.
Review in Journal of neurology, neurosurgery, and psychiatry, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Meta-analysis of outcomes following intravenous thrombolysis in patients with ischemic stroke on direct oral anticoagulants.BMC neurology · 2023Pooled it
- Intravenous Thrombolysis in Patients on Direct Oral Anticoagulants: Analysis of the Get With The Guidelines Stroke Registry.Journal of the American Heart Association · 2026Article
- Urine-based point-of-care detection of direct oral anticoagulant activity in acute stroke-accuracy at anti-Xa thresholds relevant for intravenous thrombolysis.Research and practice in thrombosis and haemostasis · 2026Article
- Safety of tenecteplase versus alteplase for intravenous thrombolysis in acute ischemic stroke patients with direct oral anticoagulation: experience from a German stroke center.Neurological research and practice · 2025Article
- Recent intake of direct oral anticoagulants and acute ischemic stroke: real world data from a comprehensive stroke center.Neurological research and practice · 2025Article
- Intravenous thrombolysis and mechanical thrombectomy in acute stroke patients on direct oral anticoagulants.Journal of neurology · 2024Review
- Thrombolysis for ischaemic stroke despite direct oral anticoagulation.Stroke and vascular neurology · 2024Article
- Outcomes of mechanical thrombectomy in orally anticoagulated patients with anterior circulation large vessel occlusion: a propensity-matched analysis of the Imperial College Thrombectomy Registry.Journal of neurology · 2023Observational
- Management and Prognosis of Acute Stroke in Atrial Fibrillation.Journal of clinical medicine · 2023Review
- Observational
- Andexanet Alfa to Reverse the Effect of Factor Xa Inhibitors in Intracranial Hemorrhage.CNS drugs · 2023Review
- [Intravenous thrombolysis of ischemic stroke-Current status].Der Nervenarzt · 2023Article
- Standard operating procedure for idarucizumab reversal of dabigatran anticoagulation in ischemic and hemorrhagic stroke.Journal of thrombosis and thrombolysis · 2023Review
- Urine-based point-of-care testing for factor-Xa-inhibitors in acute ischemic stroke patients: a feasibility study.Frontiers in neurology · 2023Article
- Intravenous Thrombolysis With Alteplase at 0.6 mg/kg in Patients With Ischemic Stroke Taking Direct Oral Anticoagulants.Journal of the American Heart Association · 2022Observational
- To Treat or Not to Treat: Low-Dose Alteplase for Patients With Acute Ischemic Stroke Taking Direct Oral Anticoagulants Within 24 Hours.Journal of the American Heart Association · 2022Article
- Efficacy and safety of bridging thrombolysis initiated before transfer in a drip-and-ship stroke service.Stroke and vascular neurology · 2022Article
- Bridging intravenous thrombolysis in patients with atrial fibrillation.Frontiers in neurology · 2022Article
- Intravenous thrombolysis in patients taking direct oral anticoagulants (ESO IVT guidelines comment).European stroke journal · 2021Article
- Challenges of Acute Ischemic Stroke Treatment in Orally Anticoagulated Patients via Telemedicine.Journal of clinical medicine · 2021Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Direct oral anticoagulants (DOACs) have emerged as primary therapeutic option for stroke prevention in patients with atrial fibrillation. However, patients may have ischaemic stroke despite DOAC therapy and there is uncertainty whether those patients can safely receive intravenous thrombolysis or mechanical thrombectomy. In this review, we summarise and discuss current knowledge about different approaches to select patient. Time since last DOAC intake-as a surrogate for anticoagulant activity-is easy to use but limited by interindividual variability of drug pharmacokinetics and long cut-offs (>48 hours). Measuring anticoagulant activity using drug-specific coagulation assays showed promising safety results. Large proportion of patients at low anticoagulant activity seem to be potentially treatable but there remains uncertainty about exact safe cut-off values and limited assay availability. The use of specific reversal agents (ie, idarucizumab or andexanet alfa) prior to thrombolysis is a new emerging option with first data reporting safety but issues including health economics need to be elucidated. Mechanical thrombectomy appears to be safe without any specific selection criteria applied. In patients on DOAC therapy with large vessel occlusion, decision for intravenous thrombolysis should not delay thrombectomy (eg, direct thrombectomy or immediate transfer to a thrombectomy-capable centre recommended). Precision medicine using a tailored approach combining clinicoradiological information (ie, penumbra and vessel status), anticoagulant activity and use of specific reversal agents only if necessary seems a reasonable choice.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.