Efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke on direct oral anticoagulants
10.3760/cma.j.issn.1673-4165.2024.11.001
- VernacularTitle:静脉溶栓在正在使用直接口服抗凝药的急性缺血性卒中患者中的有效性和安全性
- Author:
Liang SONG
1
;
Shengqi FU
;
Lili ZHU
;
Meng YU
;
Haitao LIU
;
Baoyang SHI
;
Hongtao ZHANG
Author Information
1. 河南中医药大学第五临床医学院（郑州人民医院）神经内科，郑州 450003
- Keywords:
Ischemic stroke;
Anticoagulants;
Thrombolytic therapy;
Treatment outcome;
Intracranial hemorrhages
- From:
International Journal of Cerebrovascular Diseases
2024;32(11):801-806
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) who are currently using direct oral anticoagulants (DOACs).Methods:Patients with AIS admitted to the Stroke Center of Zhengzhou People's Hospital from January 2021 to December 2024 and had taken DOACs within 48 hours prior to onset were included retrospectively. The demographic characteristics, vascular risk factors, laboratory test results, baseline National Institutes of Health Stroke Scale (NIHSS) scores, and other clinical data were collected. The main outcome measure was the functional outcome evaluated using the modified Rankin Scale at 90 days after onset, with a score of 0-2 defined as good outcome. The secondary outcome measures were symptomatic intracranial hemorrhage (sICH) and any bleeding in any location occurring within 36 hours after onset. Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome. Results:A total of 153 patients were included, with 87 males (56.9%), aged (71.261±6.983) years. Seventy-four patients (48.4%) underwent IVT, and 59 (38.6%) had poor outcome. The good outcome rate in the IVT group was significantly higher than that in the non-IVT group (71.6% vs. 51.9%; χ2=6.274, P=0.012), but there was no significant difference in the incidence of sICH and any bleeding in any location. The baseline NIHSS score of the good outcome group was significantly lower than that of the poor outcome group (8.817±3.677 vs. 11.203±5.060; t=3.361, P<0.001), and the proportion of IVT was significantly higher than that of the poor outcome group (56.4% vs. 35.6%; χ2=6.274, P=0.012). Multivariate logistic regression analysis showed that previous history of stroke or transient ischemic attack (odds ratio [ OR] 3.964, 95% confidence interval [ CI] 1.611-9.753; P=0.003) and high baseline NIHSS score ( OR 1.129, 95% CI 1.034-1.233; P=0.007) were independently associated with the poor outcome, while IVT was independently associated with the good outcome ( OR 0.166, 95% CI 0.068-0.410; P<0.001). Conclusion:For patients with AIS who had taken DOACs within 48 hours before onset, IVT can significantly improve the outcome without increasing the risk of sICH.
