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. Intervention: Direct oral anticoagulants (DOACs).

Matija Zupan; Mišo Šabovič; Senta Frol

doi:10.1186/s42466-026-00484-6

June 2, 2026Neurological Research and PracticeOpen Access

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

Address the safety of reperfusion therapies and intracranial hemorrhage risks in patients presenting with acute ischemic stroke while receiving direct oral anticoagulants.
Critically appraised findings from the prospective, multicenter RASUNOA-Prime registry evaluating ischemic stroke outcomes under oral anticoagulation.
Assessed study strengths including a predefined recruitment strategy and centralized blinded neuroimaging evaluation.
Evaluated clinical implications regarding intravenous thrombolysis contraindications and pharmacological reversal strategies prior to reperfusion.
Noted approximately 10% of acute ischemic stroke patients are taking an oral anticoagulant at presentation.
Highlighted low rates of symptomatic intracranial hemorrhage and comparable bleeding risk across anticoagulation groups, including direct oral anticoagulants, after adjusting for thrombolytic therapy.
Reported lower initial stroke severity in direct oral anticoagulant-treated patients, biologically consistent with smaller infarct volumes and reduced thrombus stability.

PICO

P

Population

Acute ischemic stroke

I

Intervention / Comparator

Direct oral anticoagulants (DOACs)

Limitations

Selected patient populations in prospective registries may not fully capture the higher-risk scenarios encountered in routine emergency care.
The biological implications of immediate anticoagulation reversal remain incompletely understood.

Implication

The authors argue that emerging prospective data challenge current guidelines that consider recent DOAC use an absolute contraindication for intravenous thrombolysis in acute ischemic stroke.

Abstract

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Cite This Study

Zupan et al. (2026) conducted a letter in Acute ischemic stroke. Direct oral anticoagulants (DOACs) was evaluated.

synapsesocial.com/papers/6a3c235fd15afadd906fa0ce https://doi.org/10.1186/s42466-026-00484-6

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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

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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