Novel oral anticoagulants complicate acute stroke management, requiring confirmation of absent anticoagulant effect before thrombolysis and individualized timing for restarting therapy based on infarct size and bleeding risk.
How should acute ischemic or hemorrhagic stroke be managed in patients taking novel oral anticoagulants?
This review provides practical guidance on managing acute stroke and restarting anticoagulation in patients taking novel oral anticoagulants.
Each year, 1·0-2·0% of individuals with atrial fibrillation and 0·1-0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2-0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offers practical approaches to the management of patients receiving novel oral anticoagulants who present with an ischemic or hemorrhagic stroke. Specifically, we discuss the role of thrombolysis in anticoagulated patients with acute ischemic stroke and factors to consider concerning restarting anticoagulation after acute ischemic and hemorrhagic stroke.
Hankey et al. (2014) conducted a review in Acute ischemic and hemorrhagic stroke in patients taking novel oral anticoagulants. Novel oral anticoagulants (dabigatran, rivaroxaban, apixaban) was evaluated. Novel oral anticoagulants complicate acute stroke management, requiring confirmation of absent anticoagulant effect before thrombolysis and individualized timing for restarting therapy based on infarct size and bleeding risk.