Summary of observational studies with >10 patients describing reperfusion therapy in patients on DOAC
| Author, year | DOAC | Intravenous thrombolysis (IVT) | Endovascular thrombectomy (EVT) | ||||||
| n | Strategy for IVT | sICH n(%) | n | Proportion receiving IVT | EVT success (TICI2B-3) | sICH n(%) | Comments | ||
| Rebello 201525 | Dabigatran, rivaroxaban, apixaban | – | – | – | 17 | Not reported | 14 (82%) | Not reported. 2 (11%) patients had parenchymal haemorrhage type 1, none had type 2. | |
| Seiffge 201521 | All | 51 | Partly plasma level based but heterogeneous selection criteria | 2 (4.0%) | 33 | 6 | Not reported | 0 | |
| Purrucker 201626 | Dabigatran, rivaroxaban, apixaban | 5 | Not specified but likely based drug specific activity | 1 (20%) | 28 | 5 (17.9%) | 16 (57%) | 1 (3.6%) | Primary EVT analysis. The patient with SICH had received IVT and EVT (vessel perforation) |
| Xian 201727 | Dabigatran, rivaroxaban, apixaban | 251 | Not reported | 12 (4.8%) | – | – | – | – | |
| Kurowski 201715 | Dabigatran, rivaroxaban, apixaban | – | – | – | 20 | 0 | Not reported | 0 | |
| Suzuki 201728 | All | 71 | INR ≤1.7, APTT <40 s | 0 | 44 | 15/44 | Not reported | 2/44 | |
| Chen 201729 | Rivaroxaban | 10 | Not reported | 0 | – | – | – | – | |
| Wong 201817 | Dabigatran, Rivaroxaban, Apixaban | – | – | – | 13 | 0 | Not specifically reported | 0 | Included only IVT ineligible patients |
| Černík 201816 | Not reported | – | – | – | 15 | Not reported | 11/15 (73%) | 0 | |
| Hoyer 201830 | Not reported | 8 | Not reported | 0 | 10 | Not reported | Not reported | 0 | |
| Pretnar Oblak 201831 | Dabigatran | 11 | Idarucizumab reversal | 1 (9.1%) | – | – | – | – | |
| Šaňák 201832 | Dabigatran | 13 | Idarucizumab reversal | 1 (7.7%) | 1 | 1 (100%) | Not reported | – | Primary IVT paper |
| Fang 201933 | Dabigatran | 10 | Idarucizumab reversal | 1 (10%) | 1 | 1 (100%) | Not reported | 0 | Primary IVT paper |
| Marsch 201924 | All | 24 | Drug-specific plasma level (<50 to 100 ng/mL) used for selection. Excluded patients with idarucizumab reversal | 1 (4.2%) | 17 | 14 (82.3%) | 16/17 (94.1%) | 1 (5.9%) | |
| Ramos-Araque 202034 | Not reported | 3 | Not reported | Not reported | 81 | 3 | 72/72 (88.9%) | 1 (1.2%) | |
| Barber 202035 | Dabigatran | 51 | Idarucizumab reversal | 2 (3.9%) | 8 | 8 (100%) | Not reported | 1 (12.5%) | Primary IVT paper |
| Beharry 202036 | Dabigatran | 13 | Idarucizumab reversal | 0 | 7 | 7 | Not reported | 0 | Primary IVT paper Tenecteplase |
| Kermer 202037 | Dabigatran | 80 | Idarucizumab reversal | 0 | 7 | 7 | Not reported | 0 | Primary IVT paper |
| Meinel 202038 | All | 7 | Not reported | Not reported | 98 | 7 (7.1%) | 68/98 (69.4%) | 5 (4.5%) | Primary EVT paper |
| Küpper14 2020 | All | 91 | Not available | Any ICH at 24 hours 11% | 827 | 91 | 701/822 (85.3%) | 97 (11.7%) | |
| L’Allinec 202039 | Dabigatran, Rivaroxaban, Apixaban | – | – | – | 115 | Excluded from report | 103/112 (92%) | 6/105 (5.7%) | |
| Goldhoorn 202018 | Not reported | – | – | – | 98 | Not reported specifically for DOAC subgroup | 56/86 (65%) | 1/98 (1%) | vs 6% SICH in warfarin MR CLEAN Registry |
| Meinel 202138 | All | 69 | Mainly based on drug-specific coagulation assays | 2 (3.1%) | 170 | N/A | N/A | 2/170 (1.3%) | |
Due to overlapping patients, data on IVT and EVT are listed separately.
mTICI, modified thrombolysis in cerebral infarction score.
DOAC, direct oral anticoagulant; ICH, intracranial haemorrhage; N/A, not available; SICH, symptomatic intracranial haemorrhage.