Department of Neurology, Brown University, 593 Eddy Street APC 5, Providence, RI 02903, USA.
Department of Hematology, Brown University, Providence, RI, USA.
J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106612. doi: 10.1016/j.jstrokecerebrovasdis.2022.106612. Epub 2022 Jul 18.
Direct oral anticoagulant (DOAC) ingestion within 48 h is an exclusion for thrombolysis in acute ischemic stroke (AIS) patients. We aim to shed light on pharmacokinetic correlates and outcomes in patients with AIS excluded from thrombolysis due to DOAC use.
This is a single center retrospective study of consecutive patients with AIS within 4.5 h from last known normal and excluded from thrombolytic therapy due to confirmed Xa inhibitor DOAC (DOAC) intake within the prior 48 h. We used linear regression to test the correlation between time from last DOAC ingestion and anti-Xa level.
Over a period of 2.5 years, we identified 44 patients who did not receive thrombolysis because of presumed DOAC intake within 48 h. In adjusted linear regression, there was an association between time from last DOAC ingestion and Xa level (beta = -0.69, p < 0.001). Among the 37 patients with known atrial fibrillation not receiving alteplase due to DOAC use, the 90-day mortality was 35.1% (13/37) and 77% (10/13) of deaths were stroke related.
Patients with AIS on DOAC therapy face a heightened risk of mortality. Studies are needed to investigate the safety and efficacy of thrombolysis in such patients based on time of last DOAC ingestion and/or anti-Xa/drug level.
在急性缺血性脑卒中（AIS）患者中，48 小时内直接口服抗凝剂（DOAC）的摄入是溶栓治疗的排除指征。我们旨在阐明由于 DOAC 使用而被排除在溶栓治疗之外的 AIS 患者的药代动力学相关性和结局。
这是一项单中心回顾性研究，纳入了发病 4.5 小时内且最后一次已知正常的 AIS 患者，由于在之前的 48 小时内确认 Xa 抑制剂 DOAC（DOAC）摄入，这些患者被排除在溶栓治疗之外。我们使用线性回归来测试从最后一次 DOAC 摄入到抗 Xa 水平的时间与抗 Xa 水平之间的相关性。
在 2.5 年的时间里，我们确定了 44 名患者因推测在 48 小时内摄入 DOAC 而未接受溶栓治疗。在调整后的线性回归中，最后一次 DOAC 摄入与 Xa 水平之间存在关联（β=-0.69，p<0.001）。在 37 名因 DOAC 使用而未接受阿替普酶的已知患有心房颤动且未接受溶栓治疗的患者中，90 天死亡率为 35.1%（13/37），其中 77%（10/13）的死亡与卒中相关。
接受 DOAC 治疗的 AIS 患者面临更高的死亡风险。需要进行研究，根据最后一次 DOAC 摄入和/或抗 Xa/药物水平，来调查此类患者溶栓治疗的安全性和有效性。
