In Taiwan, the use of non–vitamin K antagonist oral anticoagulants (NOACs) before alteplase-treated acute ischemic stroke did not increase the risk of intracranial hemorrhage, major bleeding, or mortality, according to a cohort study with meta-analysis. However, the authors caution, “given that these findings were not based on randomized clinical trials, they should be interpreted with caution. Physicians should not lower their guard on the cotreatment of alteplase and NOACs, as this practice is not recommended by current guidelines. Further large-scale prospective studies are warranted to corroborate our findings.”
The study identified 7,483 patients treated with alteplase for acute ischemic stroke in Taiwan’s National Health Insurance Research Database from 2011 to 2020. NOAC treatment was defined as the use of the agents in 2 days before stroke; their results were compared with patients on warfarin or no anticoagulants. The meta-analysis compared the results of this study with those of previous trials. The primary outcome was intracranial hemorrhage after intravenous alteplase during the index hospitalization (the hospitalization subsequent to alteplase administration).
“Of the 7,483 included patients (mean [SD] age, 67.4 [12.7] years; 2,908 [38.9%] female individuals and 4,575 [61.1%] male individuals), 91 (1.2%), 182 (2.4%), and 7210 (96.4%) received NOACs, warfarin, and no anticoagulants prior to their stroke, respectively,” the authors write. “Compared to patients who were not treated with anticoagulants, those treated with NOACs did not have significantly higher risks of intracranial hemorrhage (risk difference [RD], 2.47% [95% CI, −4.23% to 9.17%]; OR, 1.37 [95% CI, 0.62-3.03]), major bleeding (RD, 4.95% [95% CI, −2.56% to 12.45%]; OR, 1.69 [95% CI, 0.83-3.45]), or in-hospital mortality (RD, −4.95% [95% CI, −10.11% to 0.22%]; OR, 0.45 [95% CI, 0.15-1.29]) in the propensity score–matched analyses. Furthermore, the risks of bleeding and mortality were not significantly different between patients treated with NOACs and those treated with warfarin. Similar results were obtained in the meta-analysis.”