Department of Vascular Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241279545. doi: 10.1177/10760296241279545.
Direct oral anticoagulants (DOACs) changed stroke prevention and decreased the risk of ischemic and hemorrhagic complications in patients on oral anticoagulation (OAC) therapy. The numbers of patients prescribed DOACs has increased rapidly. Availability of specific reversal agents opened new avenues in the prevention and management of DOAC complications. An ideal specific reversal agent for a DOAC in acute stroke is an agent which lacks safety concerns and immediately reverses DOAC anticoagulation activity, thereby enabling effective treatment. Reversal of anticoagulant activity is mandatory in patients with acute ischemic stroke (AIS) before performing therapeutic procedures such as intravenous thrombolysis (IVT) and neurosurgery in intracranial hemorrhage (ICH) in order to improve clinical outcomes. In this manuscript we pursue an interdisciplinary approach in discussing advantages and concerns of specific reversal agents in acute stroke DOAC-treated patients in everyday clinical practice.
直接口服抗凝剂（DOACs）改变了卒中预防策略，并降低了口服抗凝治疗（OAC）患者的缺血性和出血性并发症风险。处方 DOAC 的患者数量迅速增加。特异性逆转剂的出现为预防和管理 DOAC 并发症开辟了新途径。对于急性卒中患者的 DOAC，理想的特异性逆转剂应该是一种没有安全性问题且能立即逆转 DOAC 抗凝活性的药物，从而实现有效的治疗。在进行治疗性操作（如急性缺血性卒中（AIS）患者的静脉溶栓（IVT）和颅内出血（ICH）患者的神经外科手术）之前，有必要逆转抗凝活性，以改善临床结局。在本文中，我们采用跨学科方法讨论了在日常临床实践中，特异性逆转剂在急性卒中 DOAC 治疗患者中的优势和关注点。
