Annals of Indian Academy of Neurology
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AIAN REVIEW
Year : 2022  |  Volume : 25  |  Issue : 6  |  Page : 1036-1046

Safety of recanalization therapy in acute ischemic stroke patients on direct oral anticoagulant therapy: An updated systematic review and meta-analysis


Department of Neurology, Shaoxing People's Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, China

Correspondence Address:
Yanxing Zhang
Department of Neurology, Shaoxing Peoplefs Hospital, (Shaoxing Hospital, Zhejiang University School of Medicine), North Road of Zhongxing No. 568 Shaoxing City, Zhejiang Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.aian_271_22

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This review provides an updated assessment of the safety of recanalization therapy for Acute Ischemic Stroke (AIS) patients receiving direct oral anticoagulants (DOAC) therapy. We checked the literature for published observational from 1st January 1950 to 31st March 2021. The rate of symptomatic intracerebral hemorrhage (sICH), arterial recanalization rate, good functional recovery, and mortality at 3 months were investigated, and data were expressed as Risk ratio (RR) with a 95% confidence interval (CI). Publication bias, sensitivity analysis, and meta-regression analyses were conducted utilizing STATA software. 17 articles [14 for endovascular therapy (EVT) and 3 intravenous thrombolysis for (IVT)] were finally included in the review. AIS patients with DOAC therapy showed a decreased rate of sICH (RR = 0.85, 95% CI = 0.72 to 1.00, P = 0.04), and lower probability of good functional recovery at three months (RR = 0.79, 95% CI = 0.73 to 0.85, P < 0.001) than patients without anticoagulation therapy post EVT. However, no significant differences in sICH rates in AIS patients with DOAC therapy after IVT (RR = 0.87, 95% CI = 0.48 to 1.58, P = 0.64) were observed. AIS patients not prescribed DOAC after EVT had a higher mortality risk (RR = 1.29, 95% CI = 1.15–1.44, P < 0.001). Patients with AIS on DOAC therapy were found to have a lower incidence of sICH following EVT. However, no evidence of an increased bleeding risk in patients previously treated with DOAC after IVT was observed. Therefore, more detailed studies with biological data to monitor compliance and details on the size and etiology/severity of the incident ischemic lesion is needed.


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