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Review
. 2024 Nov;96(5):871-886.
doi: 10.1002/ana.27058. Epub 2024 Sep 11.

Before, during, and after: An Argument for Safety and Improved Outcome of Thrombolysis in Acute Ischemic Stroke with Direct Oral Anticoagulant Treatment

Sanaz Monjazeb  1 , Heather V Chang  2 , Patrick D Lyden  1   2
Affiliations
Review

Before, during, and after: An Argument for Safety and Improved Outcome of Thrombolysis in Acute Ischemic Stroke with Direct Oral Anticoagulant Treatment

Sanaz Monjazeb et al. Ann Neurol. 2024 Nov.

Abstract

Direct oral anticoagulants are the primary stroke prevention option in patients with atrial fibrillation. Anticoagulant use before stroke, however, might inhibit clinician comfort with thrombolysis if a stroke does occur. Resuming anticoagulants after ischemic stroke is also problematic for fear of hemorrhage. We describe extensive literature showing that thrombolysis is safe after stroke with direct anticoagulant use. Early reinstitution of direct anticoagulant treatment is associated with lower risk of embolic recurrence and lower hemorrhage risk. The use of direct anticoagulants before, during, and after thrombolysis appears to be safe and is likely to promote improved outcomes after ischemic stroke. ANN NEUROL 2024;96:871-886.

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Conflict of interest statement

Potential Conflicts of Interest

The authors report no conflicts of interest

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