Management of acute stroke in patients taking novel oral anticoagulants
Open accessAbstract
Each year, 1·0-2·0% of individuals with atrial fibrillation and 0·1-0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2-0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offers practical approaches to the management of patients receiving novel oral anticoagulants who present with an ischemic or hemorrhagic stroke. Specifically, we discuss the role of thrombolysis in anticoagulated patients with acute ischemic stroke and factors to consider concerning restarting anticoagulation after acute ischemic and hemorrhagic stroke.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Systemic thrombolysis is contraindicated in patients on therapeutic oral anticoagulation.
“Systemic thrombolysis is contraindicated in patients on therapeutic OAC.472,473”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [473]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Dabigatran versus warfarin in patients with atrial fibrillation
Connolly, S. J., Ezekowitz, M. D., Yusuf, S., Eikelboom, J., Oldgren, J., Parekh, A., Pogue, J., Reilly, P. A., Themeles, E., Varrone, J., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0905561 · Cited by 11,215 · see citing works
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation
Patel, M. R., Mahaffey, K. W., Garg, J., Pan, G., Singer, D. E., Hacke, W., Breithardt, G., Halperin, J. L., Hankey, G. J., Piccini, J. P., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1009638 · Cited by 9,430 · see citing works
Self-citationApixaban versus warfarin in patients with atrial fibrillation
Granger, C. B., Alexander, J. H., McMurray, J. J. V., Lopes, R. D., Hylek, E. M., Hanna, M., Al-Khalidi, H. R., Ansell, J., Atar, D., Avezum, A., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1107039 · Cited by 8,943 · see citing works
Guidelines for the Early Management of Patients With Acute Ischemic Stroke
Jauch, E. C., Saver, J. L., Adams, H. P., Bruno, A., Connors, J. J. “., Demaerschalk, B. M., Khatri, P., McMullan, P. W., Qureshi, A. I., Rosenfield, K., et al. (2013) · Stroke · doi:10.1161/str.0b013e318284056a · Cited by 7,648 · see citing works
Gage, B. F., Waterman, A. D., Shannon, W., Boechler, M., Rich, M. W., & Radford, M. J. (2001) · JAMA · doi:10.1001/jama.285.22.2864 · Cited by 4,832 · see citing works
Pisters, R., Lane, D. A., Nieuwlaat, R., de Vos, C. B., Crijns, H. J. G. M., & Lip, G. Y. H. (2010) · CHEST Journal · doi:10.1378/chest.10-0134 · Cited by 4,517 · see citing works
Oral Rivaroxaban for Symptomatic Venous Thromboembolism
(2010) · New England Journal of Medicine · doi:10.1056/nejmoa1007903 · Cited by 3,237 · see citing works
Büller (2012) · doi:10.1056/nejmoa1113572 · Cited by 2,353 · see citing works
Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke
Broderick, J. P., Palesch, Y. Y., Demchuk, A. M., Yeatts, S. D., Khatri, P., Hill, M. D., Jauch, E. C., Jovin, T. G., Yan, B., Silver, F. L., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1214300 · Cited by 1,806 · see citing works
A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke
Kidwell, C. S., Jahan, R., GORNBEIN, J. A., Alger, J. R., Nenov, V., Ajani, Z. A., Feng, L., Meyer, B. C., Olson, S. E., Schwamm, L. H., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1212793 · Cited by 1,381 · see citing works
Stangier, J., Haertter, S., Liesenfeld, K., Wienen, W., Feuring, M., Clemens, A., & van Ryn, J. (2010) · Thrombosis and Haemostasis · doi:10.1160/th09-11-0758 · Cited by 1,378 · see citing works
Endovascular Treatment for Acute Ischemic Stroke
Ciccone, A., Valvassori, L., Nichelatti, M., Sgoifo, A., Ponzio, M., Sterzi, R., & Boccardi, E. P. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1213701 · Cited by 1,321 · see citing works
Saver, J. L., Jahan, R., Levy, E. I., Jovin, T. G., Baxter, B., Nogueira, R. G., Clark, W. M., Budzik, R. F., & Zaidat, O. O. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61384-1 · Cited by 1,299 · see citing works
Broderick, J., Connolly, S., Feldmann, E., Hanley, D., Kase, C., Krieger, D., Mayberg, M., Morgenstern, L., Ogilvy, C. S., Vespa, P., et al. (2007) · Stroke · doi:10.1161/strokeaha.107.183689 · Cited by 1,125 · see citing works
Nogueira, R. G., Lutsep, H. L., Gupta, R. G., Jovin, T. G., Albers, G. W., Walker, G. A., Liebeskind, D. S., & Smith, W. S. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61299-9 · Cited by 1,109 · see citing works
Heidbuchel, H., Verhamme, P., Alings, M., Antz, M., Hacke, W., Oldgren, J., Sinnaeve, P., Camm, A. J., & Kirchhof, P. (2013) · Europace · doi:10.1093/europace/eut083 · Cited by 792 · see citing works
Self-citationLu, G., DeGuzman, F. R., Hollenbach, S. J., Karbarz, M. J., Abe, K. Y., Lee, G., Luan, P., Hutchaleelaha, A., Inagaki, M., Conley, P. B., et al. (2013) · Nature Medicine · doi:10.1038/nm.3102 · Cited by 700 · see citing works
Nisio, M. D., Middeldorp, S., & Buller, H. R. (2005) · New England Journal of Medicine · doi:10.1056/nejmra044440 · Cited by 653 · see citing works
Clinical Pharmacokinetic and Pharmacodynamic Profile of Rivaroxaban
Mueck, W., Stampfuss, J. J., Kubitza, D., & Becka, M. (2013) · Clinical Pharmacokinetics · doi:10.1007/s40262-013-0100-7 · Cited by 615 · see citing works
A specific antidote for dabigatran: functional and structural characterization
Schiele, F., van Ryn, J., Canada, K. A., Newsome, C., Sepulveda, E., Park, J., Nar, H., & Litzenburger, T. (2013) · Blood · doi:10.1182/blood-2012-11-468207 · Cited by 561 · see citing works
Paciaroni, M., Agnelli, G., Corea, F., Ageno, W., Alberti, A., Lanari, A., Caso, V., Micheli, S., Bertolani, L., Venti, M. P., et al. (2008) · Stroke · doi:10.1161/strokeaha.107.510321 · Cited by 508 · see citing works
Edwards, D. J., Cortes, M., Datta, A., Minhas, P., Wassermann, E. M., & Bikson, M. (2013) · NeuroImage · doi:10.1016/j.neuroimage.2013.01.042 · Cited by 468 · see citing works
Antithrombotic and Thrombolytic Therapy for Ischemic Stroke
Lansberg, M. G., O'Donnell, M. J., Khatri, P., Lang, E., Nguyen‐Huynh, M. N., Schwartz, N. E., Sonnenberg, F. A., Schulman, S., Vandvik, P. O., Spencer, F. A., et al. (2012) · CHEST Journal · doi:10.1378/chest.11-2302 · Cited by 454 · see citing works
van der Worp, H. B., & van Gijn, J. (2007) · New England Journal of Medicine · doi:10.1056/nejmcp072057 · Cited by 399 · see citing works
Lane, D. A., & Lip, G. Y. H. (2012) · Circulation · doi:10.1161/circulationaha.111.060061 · Cited by 389 · see citing works
Efficacy and Safety of the Novel Oral Anticoagulants in Atrial Fibrillation
Dentali, F., Riva, N., Crowther, M. A., Turpie, A. G. G., Lip, G. Y. H., & Ageno, W. (2012) · Circulation · doi:10.1161/circulationaha.112.115410 · Cited by 380 · see citing works
Anticoagulants for acute ischaemic stroke
Sandercock, P. A., Counsell, C. E., & Kamal, A. K. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000024.pub3 · Cited by 372 · see citing works
Guidance on the emergent reversal of oral thrombin and factor Xa inhibitors
Kaatz, S. S., Kouides, P. A., Garcia, D. A., Spyropoulos, A. C., Crowther, M. A., Douketis, J., Chan, A. K. C., James, A., Moll, S., Ortel, T. L., et al. (2012) · American Journal of Hematology · doi:10.1002/ajh.23202 · Cited by 365 · see citing works
Broderick, J. P., Connolly, E. S., Feldmann, E. G., Hanley, D. F., Kase, C. S., Krieger, D. W., Mayberg, M. R., Morgenstern, L. B., Ogilvy, C. S., Vespa, P. M., et al. (2007) · Circulation · doi:10.1161/circulationaha.107.183689 · Cited by 357 · see citing works
Wang, Z., Frost, C. E., Shenker, A., & Barrett, Y. C. (2010) · Thrombosis and Haemostasis · doi:10.1160/th10-05-0328 · Cited by 354 · see citing works
Treatment of Warfarin-Associated Intracerebral Hemorrhage: Literature Review and Expert Opinion
Aguilar, M. I., Hart, R. G., Kase, C. S., Freeman, W. D., Hoeben, B. J., García, R. C., Ansell, J., Mayer, S. A., Norrving, B. G., Rosand, J. M., et al. (2007) · Mayo Clinic Proceedings · doi:10.4065/82.1.82 · Cited by 308 · see citing works
Self-citationPaciaroni, M., Agnelli, G., Micheli, S., & Caso, V. (2007) · Stroke · doi:10.1161/01.str.0000254600.92975.1f · Cited by 307 · see citing works
Can Patients Be Anticoagulated After Intracerebral Hemorrhage?
Eckman, M. H., Rosand, J. M., Knudsen, K. A., Singer, D. E., & Greenberg, S. M. (2003) · Stroke · doi:10.1161/01.str.0000078311.18928.16 · Cited by 300 · see citing works
Hematoma Expansion following Acute Intracerebral Hemorrhage
Brouwers, H. B., & Greenberg, S. M. (2013) · Cerebrovascular Diseases · doi:10.1159/000346599 · Cited by 258 · see citing works
Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography.
Lee, R. J., Bartzokis, T. C., Yeoh, T., et al. (1991) · Stroke · doi:10.1161/01.str.22.6.734 · Cited by 241 · see citing works
Contant, G., Spiro, T. E., Perzborn, E., Guinet, C., Gourmelin, Y., Flem, L. L., Rohde, G., Martinoli, J. L., Samama, M. M., & Laboratories, F. T. R. A.-F. X. C. A. F. T. (2011) · Thrombosis and Haemostasis · doi:10.1160/th11-06-0391 · Cited by 232 · see citing works
Hawes, E. M., Deal, A. M., Funk‐Adcock, D., Gosselin, R. C., Jeanneret, C., Cook, A. M., Taylor, J., Whinna, H. C., Winkler, A. M., & Moll, S. (2013) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.12308 · Cited by 231 · see citing works
Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage
Majeed, A., Kim, Y., Roberts, R. S., Holmström, M., & Schulman, S. (2010) · Stroke · doi:10.1161/strokeaha.110.593087 · Cited by 219 · see citing works
Analysis of Randomized Controlled Trials
Peduzzi, P. N. (2002) · Epidemiologic Reviews · doi:10.1093/epirev/24.1.26 · Cited by 204 · see citing works
Poor Prognosis in Warfarin-Associated Intracranial Hemorrhage Despite Anticoagulation Reversal
Dowlatshahi, D. D., Butcher, K., Asdaghi, N., Nahirniak, S., Bernbaum, M. L., Giulivi, A., Wasserman, J. K., Poon, M.-C., & Coutts, S. B. (2012) · Stroke · doi:10.1161/strokeaha.112.652065 · Cited by 203 · see citing works
CHADS 2 , CHA 2 DS 2 -VASc, and long-term stroke outcome in patients without atrial fibrillation
Ntaios, G., Lip, G. Y. H., Makaritsis, K. P., Papavasileiou, V., Vemmou, A., Korompoki, E., Savvari, P., Manios, E. D., Milionis, H. J., & Vemmos, K. N. (2013) · Neurology · doi:10.1212/wnl.0b013e318287281b · Cited by 189 · see citing works
Steiner, T., Böhm, M., Dichgans, M., Diener, H., Ell, C., Endres, M., Epple, C., Grond, M., Laufs, U., Nickenig, G., et al. (2013) · Clinical Research in Cardiology · doi:10.1007/s00392-013-0560-7 · Cited by 183 · see citing works
Self-citationLaboratory assessment of new anticoagulants
Samama, M. M., & Guinet, C. (2011) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.2011.134 · Cited by 174 · see citing works
Intravenous Alteplase for Stroke
Keyser, J. D., Gdovinová, Z., Uyttenboogaart, M., Vroomen, P. C. A. J., & Luijckx, G. J. (2007) · Stroke · doi:10.1161/strokeaha.106.480566 · Cited by 164 · see citing works
Nunnelee, J. D. (2011) · Journal of Vascular Nursing · doi:10.1016/j.jvn.2011.03.002 · Cited by 161 · see citing works
Ntaios, G., Papavasileiou, V., Diener, H.-C., Makaritsis, K., & Michel, P. (2012) · Stroke · doi:10.1161/strokeaha.112.673558 · Cited by 152 · see citing works
Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction
Lindley, R. I., Wardlaw, J. M., Sandercock, P. A., Rimdusid, P., Lewis, S. C., Signorini, D. F., & Ricci, S. (2004) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2004.03.003 · Cited by 126 · see citing works
Long-Term Management of Patients After Venous Thromboembolism
Kearon, C. (2004) · Circulation · doi:10.1161/01.cir.0000140902.46296.ae · Cited by 121 · see citing works
Restarting Anticoagulation Therapy After Warfarin-Associated Intracerebral Hemorrhage
Claassen, D. O., Kazemi, N. J., Zubkov, A. Y., Wijdicks, E. F. M., & Rabinstein, A. A. (2008) · Archives of Neurology · doi:10.1001/archneur.65.10.1313 · Cited by 119 · see citing works
Diener, H., Foerch, C., Riess, H. B., Röther, J., Schroth, G., & Weber, R. (2013) · The Lancet Neurology · doi:10.1016/s1474-4422(13)70101-7 · Cited by 84 · see citing works
Samama, M. M., Contant, G., Spiro, T. E., et al. (2012) · Clinical and Applied Thrombosis/Hemostasis · doi:10.1177/1076029611426282 · Cited by 83 · see citing works
Safety of intravenous thrombolysis for ischemic stroke in patients treated with warfarin
Mazya, M. V., Lees, K. R., Markus, R., et al. (2013) · Annals of Neurology · doi:10.1002/ana.23924 · Cited by 73 · see citing works
Lee, J.-H., Park, K., Shin, J.-H., Cha, J., Kim, H.-Y., Kwon, J., Oh, H. G., Lee, K. B., Kim, D., Ha, S., et al. (2010) · European Neurology · doi:10.1159/000319048 · Cited by 71 · see citing works
Determination of Rivaroxaban in Human Plasma Samples
Harenberg, J., Erdle, S., Marx, S., & Krämer, R. (2012) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0032-1301415 · Cited by 66 · see citing works
Determination of Dabigatran in Human Plasma Samples
Harenberg, J., Christina, G., Marx, S., et al. (2012) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0031-1300947 · Cited by 62 · see citing works
Monitoring of Anticoagulant Effects of Direct Thrombin Inhibitors
Fenyvesi, T., Jörg, I., & Harenberg, J. (2002) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-2002-34305 · Cited by 58 · see citing works
Arima, H., Anderson, C. S., Omae, T., Woodward, M., MacMahon, S. W., Mancia, G., Bousser, M., Tzourio, C., Rodgers, A., Neal, B. C., et al. (2012) · Stroke · doi:10.1161/strokeaha.112.651448 · Cited by 57 · see citing works
Harenberg, J., MARX, S., WEISS, C., et al. (2012) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2012.04784.x · Cited by 54 · see citing works
Agnelli, G., & Paciaroni, M. (2014) · Thrombosis and Haemostasis · doi:10.1160/th13-08-0667 · Cited by 52 · see citing works
Anticoagulants for Acute Ischemic Stroke
Sandercock, P. A., Counsell, C. E., & Kamal, A. K. (2009) · Stroke · doi:10.1161/strokeaha.108.538157 · Cited by 40 · see citing works
Predictors for Recurrent Primary Intracerebral Hemorrhage
Huhtakangas, J., Löppönen, P., Tetri, S., et al. (2013) · Stroke · doi:10.1161/strokeaha.112.671230 · Cited by 38 · see citing works
Emergency reversal of anticoagulation: The real use of prothrombin complex concentrates
Desmettre, T., Dubart, A.-E., Capellier, G., Fanara, B., Puyraveau, M., Kepka, S., Coquart, J. B., Sheppard, F., & Tazarourte, K. (2012) · Thrombosis Research · doi:10.1016/j.thromres.2012.05.029 · Cited by 36 · see citing works
Anticoagulant therapy for patients with ischaemic stroke
Hankey, G. J. (2012) · Nature Reviews Neurology · doi:10.1038/nrneurol.2012.77 · Cited by 30 · see citing works
Self-citationMiedema, I., Luijckx, G. J., Keyser, J. D., et al. (2012) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2011-301794 · Cited by 30 · see citing works
Implementing the new oral anticoagulants into the hospital formulary
Palladino, M. A., Thomson, L. J., Swift, B. G., et al. (2012) · American Journal of Hematology · doi:10.1002/ajh.23208 · Cited by 13 · see citing works
Dabigatran Etexilate: Management In Acute Ischemic Stroke
Javedani, P. P., Horowitz, B. Z., Clark, W. M., et al. (2013) · American Journal of Critical Care · doi:10.4037/ajcc2013125 · Cited by 9 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
- Authors
- Hankey, G. J., Norrving, B., Hacke, W., & Steiner, T.
- Affiliations
- The University of Western Australia (AU)
- Lund University (SE)
- Heidelberg University (DE)
- Corresponding author
- Hankey, Graeme J.
- Venue
- International Journal of Stroke
- Publisher
- SAGE Publications
- Published
- 2014-06-02
- Volume
- 9
- Issue
- 5
- Pages
- 627-632
- ISSN
- 1747-4930 (ISSN-L)
- 1747-4949
- PMC
- PMC4149783
- OpenAlex
- W2023917690
- Cited by
- 63
- References
- 66
- Citations by year
- 2024: 3 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 11 · 2018: 8 · 2017: 8 · 2016: 17 · 2015: 9
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Stroke (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (University of Western Australia) (submittedVersion, cc-by-nc)
- UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by-nc)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Johns Hopkins University
- Janssen Scientific Affairs
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- acute ischemic stroke, acute hemorrhagic stroke, direct oral anticoagulants, dabigatran, rivaroxaban, apixaban, thrombolysis, intracranial hemorrhage, atrial fibrillation, venous thromboembolism
- MeSH terms
- Administration, Oral, Anticoagulants, Brain Ischemia, Humans, Thrombolytic Therapy, Intracranial Hemorrhages, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
