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Intravenous Thrombolysis in Patients on Direct Oral Anticoagulants: Analysis of the Get With The Guidelines Stroke Registry
Journal article   Open access   Peer reviewed

Intravenous Thrombolysis in Patients on Direct Oral Anticoagulants: Analysis of the Get With The Guidelines Stroke Registry

Shadi Yaghi, Liqi Shu, Eva A Mistry, Opeolu Adeoye, Lee Schwamm, Steven Messe, Mitchell S V Elkind, Malik Ghannam, Adam de Havenon, Karen Furie, …
Journal of the American Heart Association, Vol.15(1), e044321
01/06/2026
DOI: 10.1161/JAHA.125.044321
PMCID: PMC12909014
PMID: 41467386
url
https://doi.org/10.1161/JAHA.125.044321View
Published (Version of record) Open Access

Abstract

Intravenous thrombolysis for acute ischemic stroke (AIS) is a proven effective treatment. Whether thrombolysis in patients with AIS with recent direct oral anticoagulant (DOAC) use is safe and efficacious is not well established. We aimed to compare outcomes of patients with AIS and recent DOAC use who received thrombolysis to those otherwise eligible but excluded due to recent DOAC use. This study included patients for the GWTG (Get With The Guidelines) registry with a diagnosis of AIS within 4.5 hours from last known normal, on a DOAC, and either (1) received intravenous thrombolysis, or (2) were excluded from thrombolysis with coagulopathy being the only reason for exclusion. We used univariate and adjusted binary logistic regression models with clustering by site to compare the 2 groups' functional status (ambulation on discharge and discharge disposition) and reported rates of safety outcomes in the thrombolysis group. The study sample included 48 907 patients with AIS using a DOAC; 4702 received thrombolysis and 44 205 did not. In adjusted logistic regression models, patients with recent DOAC use receiving thrombolysis had increased odds of independent ambulation at discharge (odds ratio [OR], 1.35[ 95% CI, 1.21-1.50]) and home discharge (OR, 1.33 [95% CI, 1.22-1.46]). The rate of symptomatic intracranial hemorrhage with intravenous thrombolysis in patients with recent DOAC use was 3.5% (95% CI, 3.0%-4.1%). In this study, intravenous thrombolysis was associated with improved functional outcomes in patients with recent DOAC use and appeared safe. Given the study limitations, findings require validation by prospective trials.
 Stroke thrombolysis direct oral anticoagulant

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