Abstract 15530: Intravenous Thrombolysis in Patients With Ischemic Stroke on Direct Oral Anticoagulants: A Systematic Review and Meta-Analysis

Abstract

Introduction: Current guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who are on direct oral anticoagulants (DOAC). However, studies found conflicting results regarding IVT safety and functional outcomes among patients receiving DOACs. Hypothesis: Herein, we aim to investigate this association through a systematic review and meta-analysis. Methods: A comprehensive literature search was performed in PubMed, Embase, Scopus, and the Web of Science. Studies were included if they compared the outcomes of patients receiving DOACs and those without recent use of DOACs. Random-effect meta-analysis was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) for comparison of modified Rankin Score (mRS) 0-2, all-cause mortality, and symptomatic intracranial hemorrhage (sICH). Results: A total of five studies were included among which 3,408 received DOACs and 244,033 did not. Random-effect meta-analysis revealed that the functional neurological outcome (mRS 0-2) was significantly lower in patients that received DOACs (OR 0.71, 95% CI 0.62-0.81, p<0.01). However, this difference was no longer significant in the subgroup analysis of 90 days mRS 0-2 (OR 0.71, 95% 0.46-1.11, p=0.14). Regarding all-cause mortality, patients on DOAC had a higher overall mortality rate (1.26, 95% CI 1.07-1.48, p=0.01). Nevertheless, this was not true for subgroups of in-hospital and 90-days mortality, which were both insignificant. Finally, sICH did not differ between the groups (OR 0.99, 95% CI 0.70-1.39, p=0.93). Conclusions: Our results demonstrated that the use of IVT in selected patients on DOACs with stroke might be beneficial and not associated with increased risk as there was no difference between the groups in terms of sICH.