Intravenous Thrombolysis in Patients on Direct Oral Anticoagulants: Analysis of the Get With The Guidelines Stroke Registry

作者：Shadi Yaghi, Liqi Shu, Eva Mistry, Opeolu Adeoye, Lee H Schwamm, Steven R. Messé, Mitchell S.V. Elkind, Malik Ghannam, A de Havenon, Karen Furie, Ying Xian, Christopher Streib, Runqi Wangqin, Nils Henninger, Jeffrey L. Saver, Eric E. Smith · 发表于：Journal of the American Heart Association · 年份：2025 · DOI：10.1161/jaha.125.044321 · 被引用次数：2 · 研究领域：Acute Ischemic Stroke Management、Atrial Fibrillation Management and Outcomes、Blood Coagulation and Thrombosis Mechanisms

BACKGROUND: Intravenous thrombolysis for acute ischemic stroke (AIS) is a proven effective treatment. Whether thrombolysis in patients with AIS with recent direct oral anticoagulant (DOAC) use is safe and efficacious is not well established. We aimed to compare outcomes of patients with AIS and recent DOAC use who received thrombolysis to those otherwise eligible but excluded due to recent DOAC use. METHODS: This study included patients for the GWTG (Get With The Guidelines) registry with a diagnosis of AIS within 4.5 hours from last known normal, on a DOAC, and either (1) received intravenous thrombolysis, or (2) were excluded from thrombolysis with coagulopathy being the only reason for exclusion. We used univariate and adjusted binary logistic regression models with clustering by site to compare the 2 groups' functional status (ambulation on discharge and discharge disposition) and reported rates of safety outcomes in the thrombolysis group. RESULTS: The study sample included 48 907 patients with AIS using a DOAC; 4702 received thrombolysis and 44 205 did not. In adjusted logistic regression models, patients with recent DOAC use receiving thrombolysis had increased odds of independent ambulation at discharge (odds ratio [OR], 1.35[ 95% CI, 1.21-1.50]) and home discharge (OR, 1.33 [95% CI, 1.22-1.46]). The rate of symptomatic intracranial hemorrhage with intravenous thrombolysis in patients with recent DOAC use was 3.5% (95% CI, 3.0%-4.1%). CONCLUSIONS: In this study, intra...