{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T13:31:35Z","timestamp":1781530295767,"version":"3.54.1"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Although there are no trials or large cohorts to inform clinical care, current guidelines caution against giving intravenous tPA (tissue-type plasminogen activator) to patients with acute ischemic stroke who are taking non\u2013vitamin K antagonist oral anticoagulants (NOACs). We performed a literature review of intravenous tPA in patients treated with NOACs preceding stroke.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>A literature search of PubMed was performed encompassing January 2010 to March 2018. Patient characteristics, timing of last medication intake, laboratory testing, use of reversal, and outcomes \u22643 months after discharge were summarized.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>We identified 55 studies with 492 NOAC patients receiving tPA (dabigatran, 181; rivaroxaban, 215; apixaban, 40; and unspecified NOAC, 56). Among patients with complete data, the median time from the last NOAC intake to symptom onset was 8 hours (interquartile range, 2.5\u201314.5), with 55.2% (80\/145) within 12 hours. Few patients underwent sensitive laboratory tests, such as thrombin time, diluted thrombin time, or anti-Xa assays before tPA administration. The overall observed rates of symptomatic intracranial hemorrhage, mortality, and favorable outcomes (National Institutes of Health Stroke Scale score, \u22641; modified Rankin Scale score, 0\u20132; or neurological improvement in the National Institutes of Health Stroke Scale score, \u22658 points) were 4.3% (20\/462), 11.3% (48\/423), and 43.7% (164\/375), respectively. Among dabigatran-treated patients, reversal with idarucizumab was associated with fewer symptomatic intracranial hemorrhage (4.5% [2\/44] versus 7.4% [8\/108]; unadjusted odds ratio, 0.60; 95% CI, 0.12\u20132.92), death (4.5% [2\/44] versus 12.0% [13\/108]; unadjusted odds ratio, 0.35; 95% CI, 0.08\u20131.61), and more favorable outcomes (79.1% [34\/43] versus 39.2% [29\/74]; unadjusted odds ratio, 5.86; 95% CI, 2.45\u201314.00), although the differences were not statistically significant for symptomatic intracranial hemorrhage and death.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>These preliminary observations suggest that tPA may be reasonably well tolerated without prohibitive risks of bleeding complications in selected patients on NOACs. Reversal of anticoagulant effects by idarucizumab for dabigatran-treated patients before tPA is an emerging strategy that was associated with more favorable outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.118.022128","type":"journal-article","created":{"date-parts":[[2018,9,4]],"date-time":"2018-09-04T15:56:51Z","timestamp":1536076611000},"page":"2237-2240","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Intravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non\u2013Vitamin K Antagonist Oral Anticoagulants Preceding Stroke"],"prefix":"10.1161","volume":"49","author":[{"given":"Chen","family":"Jin","sequence":"first","affiliation":[{"name":"From the Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Science &amp; Peking Union Medical College, Beijing, China (C.J.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Medicine, Duke University, Durham, NC (R.J.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Laskowitz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian F.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome J.","family":"Federspiel","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD (J.J.F.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee H.","family":"Schwamm","sequence":"additional","affiliation":[{"name":"Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital Heart and Vascular Center Boston, MA (D.L.B.)"},{"name":"Harvard Medical School, Boston, MA (D.L.B.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of California, Los Angeles (G.C.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xian","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (Y.X., A.F.H., E.D.P.)"},{"name":"Department of Neurology, Duke University Medical Center, Durham, NC (Y.X., D.T.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000158"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332401"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.015484"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.023940"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017981"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017206"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493016669849"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.118.022128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T14:45:53Z","timestamp":1715611553000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.118.022128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9]]},"references-count":7,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1161\/STROKEAHA.118.022128"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.118.022128","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9]]},"assertion":[{"value":"2018-04-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}