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July 22, 2025Stroke12 citationsOpen Access

Intravenous Thrombolysis in Patients With Recent Intake of Direct Oral Anticoagulants: A Target Trial Analysis and Comparison With Reversal Agent Use

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TMThomas R. MeinelPBPhilipp BueckeLDLucio D’Anna

Structured PICO

Does intravenous thrombolysis (IVT) compared to reversal agent use affect safety in patients with recent intake of direct oral anticoagulants?

P
Population
Patients with recent intake of direct oral anticoagulants (DOACs)
I
Intervention
Intravenous thrombolysis (IVT)
C
Comparator
Reversal agent use
O
Outcome
Safetysafety

Off-label intravenous thrombolysis appears safe in patients with recent direct oral anticoagulant intake, confirming prior observational data.

Limitations

  • More data and dedicated trials are needed for patients with confirmed high DOAC plasma levels
  • More data needed regarding the efficacy and safety of DOAC reversal before IVT

Abstract

This target trial confirms previous observational data regarding the safety of off-label IVT in patients with recent DOAC intake. More data and dedicated trials are needed for patients with confirmed high DOAC plasma levels and regarding the efficacy and safety of DOAC reversal before IVT.

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Cite This Study

Meinel et al. (2025) studied this question.

synapsesocial.com/papers/69d56e2975589c71d767d452https://doi.org/10.1161/strokeaha.125.051384
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