並列タイトル等Intravenous Thrombolysis With Alteplase at 0.6 mg/kg in Patients With Ischemic Stroke Taking Direct Oral Anticoagulants
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博士論文全文, 博士論文要旨, 最終試験結果の要旨, 論文審査の要旨
BackgroundWe elucidated the safety of treatment with alteplase at 0.6 mg/kg within 24 hours for patients on direct oral anticoagulants (DOACs) before ischemic stroke onset.Methods and ResultsConsecutive patients with acute ischemic stroke who underwent intravenous thrombolysis using alteplase at 0.6 mg/kg from 2011 to 2021 were enrolled from our single‐center prospective stroke registry. We compared outcomes between patients taking DOACs and those not taking oral anticoagulants within 48 hours of stroke onset. The primary safety outcome was the rate of symptomatic intracranial hemorrhage with a ≥4‐point increase on the National Institutes of Health Stroke Scale score from baseline. The efficacy outcome was defined as 3‐month modified Rankin Scale score of 0 to 2 after stroke onset. Of 915 patients with acute ischemic stroke who received intravenous thrombolysis (358 women; median age, 76 years; median National Institutes of Health Stroke Scale score, 10), 40 patients took DOACs (6 took dabigatran, 8 took rivaroxaban, 16 took apixaban, and 10 took edoxaban) within 24 hours of onset and 753 patients did not take any oral anticoagulants. The rate of symptomatic intracranial hemorrhage was comparable between patients on DOACs and those not on oral anticoagulants (2.5% versus 2.4%, P=0.95). The rate of favorable outcomes was comparable between the 2 groups (59.4% versus 58.2%, P=0.46), although the admission National Institutes of Health Stroke Scale score was higher in patients on DOACs. No significant differences showed in any intracranial hemorrhage within 36 hours or mortality at 3 months.ConclusionsIntravenous thrombolysis would be safely performed for patients on DOACs following the recommendations of the Japanese guidelines.
Takashi Okada, Takeshi Yoshimoto, Shinichi Wada, Sohei Yoshimura, Tetsuya Chiba, Shuhei Egashira, Shunsuke Kimura, Masayuki Shiozawa, Manabu Inoue, Masafumi Ihara, Kazunori Toyoda, Hiroshi Takashima and Masatoshi KogaIntravenous Thrombolysis With Alteplase at 0.6 mg/kg in Patients With Ischemic Stroke Taking Direct Oral AnticoagulantsJournal of the American Heart Association 2022;11:e025809https://doi.org/10.1161/JAHA.122.025809
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