Key result
Canadian survey finds 69% of stroke centers do not routinely use DOAC levels to guide thrombolysis.
Why the study?
Intravenous thrombolysis for ischemic stroke after recent DOAC ingestion remains controversial due to hemorrhagic risk, limited rapid testing, and inconsistent reversal strategies.
Cross-Sectional (n=13)
Yes
There is substantial variability and uncertainty in Canadian practice regarding thrombolysis for DOAC-treated stroke patients, driven by limited rapid testing and a lack of clear guidelines.
Limited rapid DOAC testing restricts thrombolysis decision-making in stroke; leaves open standardization of care pending improved assays and guidelines.
Intravenous thrombolysis for ischemic stroke after recent direct oral anticoagulant (DOAC) ingestion remains controversial due to hemorrhagic risk, limited rapid testing and inconsistent reversal strategies. We conducted an invite-only, web-based cross-sectional survey of Canadian stroke centers using a structured questionnaire. DOAC level testing was inconsistently available, with 9/13 centers (69%) reporting access but 8/13 centers (61%) reporting turnaround times exceeding 30 minutes. Consequently, 9/13 centers (69%) did not routinely use DOAC levels to guide thrombolysis decisions. Current practice demonstrates substantial variability and uncertainty, highlighting important evidence gaps and the potential role of clinical trials and consensus guideline development.
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Hosseini et al. (2026) conducted a cross-sectional in Ischemic stroke in patients on direct oral anticoagulants (n=13). A cross-sectional survey of 13 Canadian stroke centers found that 69% of centers do not routinely use DOAC levels to guide thrombolysis decisions in ischemic stroke patients.
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