Presentation, therapy and outcome of patients with ischemic stroke under new oral anticoagulants

BACKGROUND: Aim was to describe the clinical spectrum, therapy, and outcome of ischemic strokes under therapy with new oral anticoagulants (NOAC). METHODS AND RESULTS: A literature research was carried out in PubMed. Clinical trials as well as case reports were included. Four large trials comparing NOAC with warfarin reported 469 ischemic strokes but neither co-medication, nor comorbidities, location, clinical spectrum, therapy, nor outcome are reported. Eleven cases with ischemic strokes under dabigatran from the literature are reported. Six patients received thrombolytic therapy, in three of them unaware dabigatran therapy. Two patients received mechanical recanalization. Two patients died, one due to cerebral hemorrhage after thrombolysis, the other after partial recanalization of the basilar artery. CONCLUSIONS: Little is known about ischemic strokes under NOAC. To increase the knowledge, the data of 469 ischemic strokes which occurred in NOAC-investigating trials should be analyzed. Furthermore ischemic and bleeding events under NOAC outside clinical trials should be reported. An international registry, independent from the pharmaceutical industry for collecting these informations is desirable.