Management of acute stroke in patients taking novel oral anticoagulants

Authors

  • Graeme J. Hankey,

    Corresponding author
    1. School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
    • Correspondence: Graeme J. Hankey, School of Medicine and Pharmacology, The University of Western Australia, Room 222, Harry Perkins Institute of Medical Research, QQ Building, QEII Medical Centre, 6 Verdun Street, Nedlands, Perth, Western Australia 6009, Australia. E-mail: graeme.hankey@uwa.edu.au

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  • Bo Norrving,

    1. Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
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  • Werner Hacke,

    1. Department of Neurology, University of Heidelberg, Heidelberg, Germany
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  • Thorsten Steiner

    1. Department of Neurology, University of Heidelberg, Heidelberg, Germany
    2. Neurologische Klinik, Klinikum Frankfurt Höchst, Frankfurt, Germany
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  • Funding: Professor Thorsten Steiner has received honoraria from Boehringer, Bayer, and BMS–Pfizer. Professor Bo Norrving has acted as consultant for Bayer HealthCare, Servier, Syngis, Daichii Sankyo and Allergan, and has received royalties for a book published by Karolinska University Press. Professor Graeme Hankey has received honoraria for serving on the executive committees of the AMADEUS trial (Sanofi-Aventis), ROCKET AF trial (Johnson & Johnson), and the BOREALIS trial (Sanofi-Aventis), and the stroke outcome adjudication committee of the RE–LY and AVERROES trials. He has also received honoraria from Bayer, Boehringer Ingelheim, and Pfizer Australia for speaking at sponsored scientific symposia and consulting on advisory boards. Professor Werner Hacke has received honoraria from Bayer Schering for his role on the ROCKET AF executive committee, and for contributions to educational symposia and participation in advisory boards. He also receives honoraria for participation on advisory boards organized by Daiichi Sankyo.

Abstract

Each year, 1·0–2·0% of individuals with atrial fibrillation and 0·1–0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2–0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offers practical approaches to the management of patients receiving novel oral anticoagulants who present with an ischemic or hemorrhagic stroke. Specifically, we discuss the role of thrombolysis in anticoagulated patients with acute ischemic stroke and factors to consider concerning restarting anticoagulation after acute ischemic and hemorrhagic stroke.

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