{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T16:41:22Z","timestamp":1784479282374,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The management of acute ischemic stroke (AIS) in anticoagulated patients presents a clinical challenge, as concerns about safety and efficacy often limit access to recanalization therapies. Despite the widespread use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), their impact on functional recovery and mortality following intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) remains uncertain. Therefore, this study investigates the association between prior anticoagulation and 90-day outcomes in AIS patients undergoing reperfusion therapy. Methods: We conducted a retrospective cohort analysis using our institutional stroke registry, including AIS patients admitted to the Department of Neurology at our university between February 2023 and 2025. Anticoagulated patients were 1:1 propensity score-matched with non-anticoagulated controls (n = 126 per group) using Mahalanobis distance matching with a caliper, adjusting for age, sex, hypertension, diabetes, stroke severity (National Institutes of Health Stroke Scale [NIHSS] at admission and 72 h), and pre-stroke functional status (pre-morbid modified Rankin Scale [pre-mRS]). Primary endpoints at 90 days were functional independence (modified Rankin Scale [mRS] \u2264 2), mRS-shift, and mortality (mRS = 6). Predictors of outcome were assessed using multivariable logistic regression and generalized additive models (GAMs). Subgroup analyses evaluated the effects of anticoagulation type and treatment modality. Results: Among 866 AIS patients (DOAC n = 100, VKA n = 48, non-anticoagulated n = 718), 426 (49.2%) underwent reperfusion therapy (IVT n = 195, MT n = 163, IVT + MT n = 68). Before matching, anticoagulated patients were less likely to achieve functional independence (34.5% vs. 52.1%, odds ratio [OR] = 0.48, 95% confidence interval [CI] [0.33\u20130.70], p &lt; 0.001), had a greater mRS-shift (2.53 vs. 1.79, p &lt; 0.001), and higher mortality (30.4% vs. 14.5%, OR = 2.58, 95% CI [1.72\u20133.88], p &lt; 0.001). However, after matching, these differences were no longer statistically significant. NIHSS, 72hNIHSS, and pre-mRS were the strongest independent predictors of outcome (p &lt; 0.001), while anticoagulation status had no significant effect. Conclusions: Recanalization therapy was not associated with worse functional outcomes in selected anticoagulated AIS patients. These findings suggest that prior anticoagulation alone should not preclude reperfusion therapy in otherwise eligible patients, and underscore the importance of individualized, evidence-based decision-making in acute stroke care.<\/jats:p>","DOI":"10.3390\/jcm14228146","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:55:31Z","timestamp":1763556931000},"page":"8146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Trick or Treat(ment): Should We Still Fear Reperfusion Therapy in Anticoagulated Stroke Patients?\u2014Comparable 90-Day Outcomes in a Propensity-Score-Matched Registry Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2912-0092","authenticated-orcid":false,"given":"Jessica","family":"Seetge","sequence":"first","affiliation":[{"name":"Stroke Unit, Department of Neurology, University of P\u00e9cs, Ifj\u00fas\u00e1g \u00fatja 13, 7624 P\u00e9cs, Baranya, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bal\u00e1zs","family":"Cs\u00e9ke","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of P\u00e9cs, Ifj\u00fas\u00e1g \u00fatja 13, 7624 P\u00e9cs, Baranya, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zs\u00f3fia Nozomi","family":"Kar\u00e1di","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, University of P\u00e9cs, Ifj\u00fas\u00e1g \u00fatja 13, 7624 P\u00e9cs, Baranya, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edit","family":"Bosny\u00e1k","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, University of P\u00e9cs, Ifj\u00fas\u00e1g \u00fatja 13, 7624 P\u00e9cs, Baranya, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eszter Johanna","family":"Jozifek","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, University of P\u00e9cs, Ifj\u00fas\u00e1g \u00fatja 13, 7624 P\u00e9cs, Baranya, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00e1szl\u00f3","family":"Szap\u00e1ry","sequence":"additional","affiliation":[{"name":"Stroke Unit, Department of Neurology, University of P\u00e9cs, Ifj\u00fas\u00e1g \u00fatja 13, 7624 P\u00e9cs, Baranya, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021","volume":"23","author":"Feigin","year":"2024","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1056\/NEJMoa0804656","article-title":"Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke","volume":"359","author":"Hacke","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1136\/neurintsurg-2018-014569","article-title":"European Stroke Organisation (ESO)\u2014European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke","volume":"15","author":"Turc","year":"2023","journal-title":"J. Neurointerv. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Joglar","year":"2024","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1929","DOI":"10.1016\/S0140-6736(14)60584-5","article-title":"Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: A meta-analysis of individual patient data from randomised trials","volume":"384","author":"Emberson","year":"2014","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e343","DOI":"10.1161\/STR.0000000000000152","article-title":"Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals from the American Heart Association\/American Stroke Association","volume":"48","author":"Yaghi","year":"2017","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1161\/STR.0000000000000158","article-title":"2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association\/American Stroke Association","volume":"49","author":"Powers","year":"2018","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"I","DOI":"10.1177\/2396987321989865","article-title":"European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke","volume":"6","author":"Berge","year":"2021","journal-title":"Eur. Stroke J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1002\/ana.25700","article-title":"Ischemic Stroke despite Oral Anticoagulant Therapy in Patients with Atrial Fibrillation","volume":"87","author":"Seiffge","year":"2020","journal-title":"Ann. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1001\/jamaneurol.2021.0287","article-title":"Administering Thrombolysis for Acute Ischemic Stroke in Patients Taking Direct Oral Anticoagulants","volume":"78","author":"Seiffge","year":"2021","journal-title":"JAMA Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Purrucker, J.C., H\u00f6lscher, K., Kollmer, J., and Ringleb, P.A. (2020). Etiology of Ischemic Strokes of Patients with Atrial Fibrillation and Therapy with Anticoagulants. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092938"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1002\/ana.25917","article-title":"Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation","volume":"89","author":"Meinel","year":"2021","journal-title":"Ann Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1161\/01.STR.20.7.864","article-title":"Measurements of acute cerebral infarction: A clinical examination scale","volume":"20","author":"Brott","year":"1989","journal-title":"Stroke"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1161\/01.STR.19.5.604","article-title":"Interobserver agreement for the assessment of handicap in stroke patients","volume":"19","author":"Koudstaal","year":"1988","journal-title":"Stroke"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995). Tissue Plasminogen Activator for Acute Ischemic Stroke. N. Engl. J. Med., 333, 1581\u20131588.","DOI":"10.1056\/NEJM199512143332401"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1411587","article-title":"A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke","volume":"372","author":"Berkhemer","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1056\/NEJMoa1415061","article-title":"Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke","volume":"372","author":"Saver","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1056\/NEJMoa1414905","article-title":"Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke","volume":"372","author":"Goyal","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1706442","article-title":"Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct","volume":"378","author":"Nogueira","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1056\/NEJMoa1713973","article-title":"Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging","volume":"378","author":"Albers","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1177\/2396987319863606","article-title":"Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11\u201313 November 2018","volume":"4","author":"Ahmed","year":"2019","journal-title":"Eur. Stroke J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1177\/23969873241252751","article-title":"Intravenous thrombolysis in patients with recent intake of direct oral anticoagulants: A target trial analysis after the liberalization of institutional guidelines","volume":"9","author":"Jung","year":"2024","journal-title":"Eur. Stroke J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1001\/jama.2022.0948","article-title":"Association of Recent Use of Non\u2013Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients with Acute Ischemic Stroke Treated with Alteplase","volume":"327","author":"Kam","year":"2022","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1001\/jamaneurol.2022.4782","article-title":"Intravenous Thrombolysis in Patients with Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants","volume":"80","author":"Meinel","year":"2023","journal-title":"JAMA Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1161\/STROKEAHA.123.046142","article-title":"Prime Time for a Trial Assessing Safety of Intravenous Thrombolysis in Patients Treated with Direct Oral Anticoagulants","volume":"55","author":"Boehme","year":"2024","journal-title":"Stroke"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1002\/ana.27189","article-title":"Intravenous Thrombolysis in Patients Taking Direct Oral Anticoagulation Treatment Before Stroke Onset: Results from the Safe Implementations of Treatments in Stroke International Stroke Registry","volume":"97","author":"Matusevicius","year":"2025","journal-title":"Ann. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4192","DOI":"10.1007\/s00415-023-11815-x","article-title":"Safety and efficacy of intravenous thrombolysis in patients with acute ischemic stroke taking direct oral anticoagulants prior to stroke: A meta-analysis","volume":"270","author":"Liang","year":"2023","journal-title":"J. Neurol."},{"key":"ref_28","first-page":"E842","article-title":"MT in anticoagulated patients","volume":"94","author":"Sibon","year":"2020","journal-title":"Neurology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1007\/s00415-020-10369-6","article-title":"Endovascular stroke treatment in orally anticoagulated patients: An analysis from the German Stroke Registry-Endovascular Treatment","volume":"268","author":"Feil","year":"2021","journal-title":"J. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1161\/STROKEAHA.119.028675","article-title":"Endovascular Treatment for Acute Ischemic Stroke in Patients on Oral Anticoagulants","volume":"51","author":"Goldhoorn","year":"2020","journal-title":"Stroke"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8146\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T13:22:19Z","timestamp":1763558539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/8146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":30,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14228146"],"URL":"https:\/\/doi.org\/10.3390\/jcm14228146","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,17]]}}}