Recent NOAC use does not increase ICH risk in stroke patients undergoing thrombolysis: JAMA study

The primary outcome was symptomatic intracranial hemorrhage occurring within 36 hours after intravenous alteplase administration. There were 4 secondary safety outcomes, including inpatient mortality, and 7 secondary functional outcomes assessed at hospital discharge, including the proportion of patients discharged home.

Among these patients who all received alteplase, 2207 had taken a NOAC within the previous 7 days before stroke onset and alteplase treatment. The rate of symptomatic intracranial hemorrhage was 3.7% among patients taking NOACs compared with 3.2% among patients not taking any anticoagulants, with no statistically significant difference between groups.

Additional analyses showed no significant differences in inpatient and 4 of the 7 secondary functional outcomes showed significant differences in favor of the NOAC group after adjustment.

"Compared with patients not taking any anticoagulants, patients taking NOACs were significantly more likely to be discharged home, ambulate independently, and have less global disability at discharge" note authors.

Two major conclusions can be drawn from this study. First, the use of intravenous alteplase in patients with ischemic stroke and prior NOAC intake within 7 potentially appears to be safe.

Second, less than 9% of patients taking NOACs but otherwise potentially eligible for alteplase therapy received this treatment. This underscores the significance of this data to shape future trials that can further clarify the issue of NOAC safety so that all eligible patients do not miss the vital thrombolytic therapy.

Source: JAMA Cardiology : doi:10.1001/jama.2022.0948