Table 3

Observational studies including patients on direct oral anticoagulant (DOAC) treated with intravenous thrombolysis

StudyNumber of patients (DOAC type)Number of sICH/rateNumber of patients (comparator)Number of sICH/rateComment
Heterogenous or unknown selection criteria (n=5 studies, n=475 patients)
 Xian et al 12 251 (all DOAC)12 (4.8%)1500 (VKA)73 (4.9%)No selection criteria or information on anticoagulation available
 Seiffge et al 11 78 (all DOAC)2 (3.9%)441 (VKA) and 8938 (no anticoagulation)9.3% and 7.2%Heterogenous selection criteria, all within 48 hours, partly plasma level-based
 Suzuki et al 10 71 (all DOAC)2%n/an/aNational survey and case collection, (dosage of rt-PA: 0.6 mg/kg)
 Shahjouei et al 14 6 (dabigatran)0n/an/aCase collection
 Meinel et al 33 69 (all DOAC)3.1%1544 (no anticoagulation) and 156 (VKA with INR <1.7)3.6% (no) and 4.6% (VKA)18 of 23 centres used DOAC plasma levels for patient selection
DOAC plasma-level based approach (n=3 studies, n=36 patients)
 Marsch et al 46 9 (all DOAC)1 (4.2%)31 VKA1 (3.3%)All patients <48 hours of last intake
 Seiffge et al 28 18 (rivaroxaban)0n/an/a
 Purrucker et al 8 9 (all DOAC)0n/an/a
Idarucizumab (n=8 studies, n=236 patients)
 Beharry et al 13 (dabigatran)0n/an/aTenecteplase
 Barber et al 51 (dabigatran)2 (3.9%)1285 (all non-DOA)49 (3.8%)
 Kermer et al 80 (dabigatran)0n/a
 Küpper et al 7 (dabigatran)0n/a
 Pretnar Oblak et al 11 (dabigatran)2sICH (18.2%)n/ano9 with elevated thrombin time
 Giannandrea et al 55 (dabigatran)3 sICH (5.5%)n/an/a
 Sanak et al 13 (dabigatran)1 sICH (7.6%)
2 aICH
 Fang et al 6 (dabigatran)0n/an/a
  • INR, international normalised ratio; sICH, symptomatic intracerebral haemorrhage; VKA, vitamin K antagonist.