Abstract 4: Safety of Intravenous Thrombolysis Among Patients Taking Direct Oral Anticoagulants: A Systematic Review and Meta-analysis

Abstract

Introduction: Direct oral anticoagulants (DOACs) are increasingly being administered for atrial fibrillation and stroke prevention. The risk of symptomatic hemorrhagic transformation (sHT) following intravenous thrombolysis (IVT) among stroke patients who take DOACs is not clear. Methods: We conducted a systematic review of literature through six different resources—PubMed, Scopus, Embase, Clinicaltrial.gov, ICTRP and Cochrane library. The control groups included patients who took warfarin with INR<1.7 and patients without prior anticoagulation use. The heterogeneity between studies was assessed by χ2 test for heterogeneity. Meta-analysis was conducted by assuming the random-effect models. Results: A total of 12606 search results were retrieved. After reduction of the duplication, screening the title and abstracts and review of the candidate manuscripts, 44877 stroke patients were enrolled in this study—DOACs: 369 patients, warfarin: 1997 patients and 42511 patients without prior anticoagulation use. Pretreatment use of DOACs was not associated with increased risk of sHT compared to those who received warfarin (OR: 0.62; 95% CI: 0.23-1.71; P=0.74) or patients without prior anticoagulation use (OR: 0.89; 95% CI: 0.31- 2.56; P=0.98). Similarly, by restricting the results to last DOACs-IVT interval of 48 hours, DOACs was not associated with increased risk of sICH; neither in comparison with warfarin (OR: 0.63; 95% CI: 0.39- 1.02; P=0.82), nor with patients without prior anticoagulation use (OR: 0.89; 95% CI: 0.53- 1.48; P=0.36). Conclusion: Pretreatment use of DOACs appears not to be associated with increased risk of sHT among patients who presented with stroke symptoms and treated with IVT.