NOAC Use Not Tied to ICH in Stroke Patients Treated With Alteplase

FRIDAY, Feb. 25, 2022 (HealthDay News) -- For patients with acute ischemic stroke receiving alteplase, use of non-vitamin K antagonist oral anticoagulants (NOACs) in the previous seven days is not associated with an increased risk for intracranial hemorrhage compared with not using anticoagulants, according to a study published in the Feb. 10 issue of the Journal of the American Medical Association.

Wayneho Kam, M.D., from the Duke University Medical Center in Durham, North Carolina, and colleagues examined the safety and functional outcomes of intravenous alteplase among patients who were taking NOACs prior to stroke compared to those not taking long-term anticoagulants. Data were included for 163,038 patients with acute ischemic stroke: 1.4 percent were taking NOACs and 98.6 percent were not taking anticoagulants prior to stroke.

The researchers found that the unadjusted rate of symptomatic intracranial hemorrhage was 3.7 and 3.2 percent for those taking NOACs and not taking anticoagulants, respectively. After adjustment for baseline clinical factors, there was no significant difference observed between the groups in terms of the risk for symptomatic intracranial hemorrhage. No significant differences were seen in the secondary safety outcomes, including inpatient mortality. After adjustment, four of seven secondary functional outcomes showed significant differences in favor of the NOAC group, including the proportion of patients discharged home.

"Compared with patients not taking anticoagulants, prior use of NOACs was significantly associated with better adjusted outcomes in terms of patients being discharged home, their ambulatory status, their freedom from disability, and their functional independence at hospital discharge," the authors write.

Several authors disclosed financial ties to the pharmaceutical and technology industries.

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