Author response to Zupan et al., Letter to the editor regarding “Intracranial hemorrhage after ischemic stroke in patients on direct oral anticoagulants: results from a prospective observational study” by Purrucker et al

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Acute ischemic stroke in patients receiving oral anticoagulation. Intervention: Intravenous thrombolysis vs. Non-anticoagulated patients. Primary outcome: Symptomatic intracranial hemorrhage.

J Purrucker; Kirsten Haas; Marilen Sieber; Viktoria Rücker; Peter U. Heuschmann; Roland Veltkamp

doi:10.1186/s42466-026-00483-7

June 2, 2026Neurological Research and PracticeOpen Access

Author response to Zupan et al., Letter to the editor regarding “Intracranial hemorrhage after ischemic stroke in patients on direct oral anticoagulants: results from a prospective observational study” by Purrucker et al

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Key Points

This response addresses concerns raised about the findings related to intracranial hemorrhage after ischemic stroke in patients on anticoagulants.
Directly responds to a letter regarding findings from a specific prospective observational study.
Discusses methodology and interpretations concerning anticoagulant use and hemorrhage risk.
Clarifies the context of observed hemorrhagic events in the original study.
Emphasizes the importance of careful patient selection when using direct oral anticoagulants.

PICO

P

Population

Acute ischemic stroke in patients receiving oral anticoagulation

I

Intervention / Comparator

Intravenous thrombolysis vs Non-anticoagulated patients

O

Primary Outcome

Symptomatic intracranial hemorrhage

Limitations

Observational study design cannot provide a definitive answer regarding safety in all high-risk scenarios
Residual confounding and treatment selection may have contributed to the lower stroke severity observed in patients receiving DOACs
Not designed to determine the incremental value of reversal treatment

Implication

Low symptomatic ICH rates across groups may reassure DOAC use post-stroke; leaves open need for randomized confirmation.

Abstract

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Discussion

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Cite This Study

Purrucker et al. (2026) conducted a letter in Acute ischemic stroke in patients receiving oral anticoagulation. Intravenous thrombolysis vs. Non-anticoagulated patients was evaluated on Symptomatic intracranial hemorrhage.

synapsesocial.com/papers/6a3c235fd15afadd906fa0c4 https://doi.org/10.1186/s42466-026-00483-7

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Author response to Zupan et al., Letter to the editor regarding “Intracranial hemorrhage after ischemic stroke in patients on direct oral anticoagulants: results from a prospective observational study” by Purrucker et al

Key Points

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Author response to Zupan et al., Letter to the editor regarding “Intracranial hemorrhage after ischemic stroke in patients on direct oral anticoagulants: results from a prospective observational study” by Purrucker et al

Key Points

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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