Why the study?
Guidelines do not recommend rt-PA in patients taking DOACs, highlighting the need to evaluate the safety of fibrinolytic therapy in this population.
Does rt-PA cause major bleeding in stroke patients taking apixaban?
Does rt-PA cause major bleeding in stroke patients taking apixaban?
Administration of rt-PA in a stroke patient taking apixaban was not associated with major bleeding and resulted in complete neurological recovery, challenging current AHA/ASA guidelines.
Answers are grounded in this paper and cite their sources.
Supports rt-PA feasibility in apixaban-treated stroke; hypothesis-generating and should not change practice.
We present a case of a woman with a stroke successfully treated with rt-PA. After the administration of the fibrinolytic agent we accidentally discovered that the patient was taking apixaban 5 mg b.i.d. for her chronic atrial fibrillation. Despite the high dosage of anticoagulant administered no major bleeding occurred and the neurological deficit completely recovered. The most recent AHA/ASA guidelines do not recommend the use of rt-PA in patients taking direct oral anticoagulants (DOAC) but data from literature seem to suggest that such administration is not associated with an increased risk of mayor bleedings. Current report underlines the urgent need for new studies to evaluate the possibility of treating DOAC patients with fibrinolytic drugs.
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Dragoni et al. (2020) studied this question.
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