ArticleEuropean stroke journal2026
Beating the clock: comparing the speed of anticoagulation reversal in intracerebral haemorrhage to thrombolysis for acute ischaemic stroke.
Article in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionIntravenous thrombolysis (IVT) for acute ischaemic stroke (AIS) and anticoagulation reversal for intracerebral haemorrhage (ICH) are both emergency stroke treatments. We hypothesized that, given the similar logistics, door-to-needle times should be comparable for both treatments. PATIENTS AND
methodsWe used data from 2023 and 2024 from the Dutch Acute Stroke Audit, a national stroke registry with 66 contributing hospitals in the Netherlands. We compared door-to-needle time of patients with anticoagulation-related ICH who received a reversal agent to patients with AIS who received IVT.
resultsOf 1,897 adult patients with anticoagulation related ICH, 1018 (54%) received a reversal agent, of whom 579 (57%) had available door-to-needle times. Of 67,699 AIS patients, 14,192 (21%) received IVT and 13,752 (97%) had available door-to-needle times. ICH patients were older (80 years vs 74 years, P < .001) and had a higher NIHSS at presentation (7 vs 4, P < .001) compared to AIS patients. Onset-to-door times were longer for ICH patients than AIS patients (78 min vs 73 min, P < .001). Median door-to-needle time was 49 (IQR: 30-90) min for ICH patients and 28 (IQR: 20-41) min for AIS patients (adjusted β = -0.573; 95% CI, -0.631 to -0.515; P < .001). DISCUSSION AND
conclusionIn this nationwide study, door-to-needle time was substantially longer for anticoagulation reversal in ICH patients than IVT in AIS patients. This indicates that there is room for improvement in the emergency workflow of ICH patients.
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