Specific Reversal Agents for Direct Oral Anticoagulants in Acute Stroke.
Senta FrolJanja Pretnar OblakMišo ŠabovičWim H van ZwamGeorge NtaiosKarl Olof LövbladAndreas GruberPawel KermerPublished in: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis (2024)
Direct oral anticoagulants (DOACs) changed stroke prevention and decreased the risk of ischemic and hemorrhagic complications in patients on oral anticoagulation (OAC) therapy. The numbers of patients prescribed DOACs has increased rapidly. Availability of specific reversal agents opened new avenues in the prevention and management of DOAC complications. An ideal specific reversal agent for a DOAC in acute stroke is an agent which lacks safety concerns and immediately reverses DOAC anticoagulation activity, thereby enabling effective treatment. Reversal of anticoagulant activity is mandatory in patients with acute ischemic stroke (AIS) before performing therapeutic procedures such as intravenous thrombolysis (IVT) and neurosurgery in intracranial hemorrhage (ICH) in order to improve clinical outcomes. In this manuscript we pursue an interdisciplinary approach in discussing advantages and concerns of specific reversal agents in acute stroke DOAC-treated patients in everyday clinical practice.
Keyphrases
- direct oral anticoagulants
- venous thromboembolism
- atrial fibrillation
- end stage renal disease
- newly diagnosed
- ejection fraction
- chronic kidney disease
- acute ischemic stroke
- prognostic factors
- clinical practice
- stem cells
- patient reported outcomes
- oxidative stress
- risk factors
- high dose
- low dose
- blood brain barrier
- subarachnoid hemorrhage
- bone marrow
- chemotherapy induced