June 2, 2014International Journal of Stroke63 citationsOpen Access
Management of Acute Stroke in Patients Taking Novel Oral Anticoagulants
Resultado clave
Novel oral anticoagulants complicate acute stroke management, requiring confirmation of absent anticoagulant effect before thrombolysis and individualized timing for restarting therapy based on infarct size and bleeding risk.
PICO estructurado
How should acute ischemic or hemorrhagic stroke be managed in patients taking novel oral anticoagulants?
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Población
Patients receiving novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) who present with an ischemic or hemorrhagic stroke
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Exposición
Management strategies including thrombolysis and restarting anticoagulation
This review provides practical guidance on managing acute stroke and restarting anticoagulation in patients taking novel oral anticoagulants.
Limitaciones
- Lack of prospective clinical data regarding the optimal timing for reinstitution of anticoagulation after stroke
- Absence of widely available, rapid, and reliable quantitative point-of-care coagulation tests for NOACs
- Lack of specific reversal agents (antidotes) for NOACs at the time of publication
- Recommendations are largely based on expert opinion and retrospective data
Resumen
Each year, 1·0-2·0% of individuals with atrial fibrillation and 0·1-0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2-0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offers practical approaches to the management of patients receiving novel oral anticoagulants who present with an ischemic or hemorrhagic stroke. Specifically, we discuss the role of thrombolysis in anticoagulated patients with acute ischemic stroke and factors to consider concerning restarting anticoagulation after acute ischemic and hemorrhagic stroke.