IV-thrombolysis for ischemic stroke with unknown onset in patients on oral anticoagulation

Abstract-Text (inkl. Referenzen und Bildunterschriften)

Introduction

IV-thrombolysis in the unknown or extended time window based on multimodal imaging is recommended by international guidelines. Further, increasing evidence exists regarding IV-thrombolysis in patients on oral anticoagulation. However, data on IV-thrombolysis in ischemic stroke patients on oral anticoagulation with unknown time of stroke onset is sparse.

Methods

This study bases on the Stroke Research Consortium in Northern Bavaria (STAMINA; ClinicalTrials.gov Identifier: NCT04357899). Patients treated with IV-thrombolysis in the unknown or extended time window selected by multimodal CT or MRI were included. Patients on oral anticoagulation (vitamin-K antagonist (VKA) or direct oral anticoagulant (DOAC) within 48 hours) were eligible for IV-thrombolysis based on INR-measurement (VKA) or plasma levels (DOAC) according to an institutional protocol. We investigated the incidence of intracranial haemorrhagic complications in patients with and without oral anticoagulation at stroke onset.

Results

Of 170 ischemic stroke patients treated with IV-thrombolysis in the unknown or extended time window, 151 had no oral anticoagulation at stroke onset and 19 were on oral anticoagulation (6 on vitamin-K antagonist (VKA) and 13 on direct oral anticoagulant (DOAC)). The risk of symptomatic ICH according to ECASS II criteria was similar between the patients with and without oral anticoagulation (1 (5.3%) vs. 4 (2.7%); p=0.453). After adjustment for confounding factors pre-medication with oral anticoagulation was associated neither with any ICH (aOR 3.72 (0.87 – 15.9); p=0.076) nor with symptomatic ICH (aOR 1.02 (0.09 – 11.02); p=0.988).

Conclusion

IV-thrombolysis for ischemic stroke with unknown onset appeared safe in selected patients on oral anticoagulation.