2026/11/14 13:30-15:00 Room 401
- Precision Pharmacology in Stroke
- Time
- Topic
- Speaker
- Moderator
- 13:50-14:10
- IVT in DOAC <24h
- SPEAKER:
Shin-Yi Lin
林欣儀
Taiwan (台灣)
- MODERATOR:
Po-Lin Chen
陳柏霖
Taiwan (台灣)
Li-Kai Tsai
蔡力凱
Taiwan (台灣)
- Shin-Yi Lin
- M.S.
-
Clinical Pharmacist, Department of Pharmacy, National Taiwan University Hospital
Clinical Associate Professor, School of Pharmacy, National Taiwan University
Lecture Abstract：
The increasing incidence of atrial fibrillation (AF), together with the widespread adoption of direct oral anticoagulants (DOACs) as first-line therapy for stroke prevention, has substantially shifted anticoagulant prescribing patterns from warfarin toward DOACs. Consequently, the number of patients experiencing acute ischemic stroke (AIS) during DOAC therapy is expected to increase, posing challenges for acute stroke management.
Intravenous thrombolysis (IVT) remains a cornerstone of AIS treatment; however, its use in patients receiving DOACs raises concerns regarding intracranial hemorrhage. The 2026 American Heart Association/American Stroke Association guidelines acknowledge the uncertainty surrounding the safety of IVT in patients with DOAC exposure within the preceding 48 hours. Nevertheless, emerging observational evidence suggests that IVT may be safe in selected patients with DOAC exposure ranging from 48 hours to as long as 7 days before treatment. However, most studies lack DOAC concentration measurements at the time of thrombolysis, limiting the interpretation of these findings.
Our recent study conducted at a tertiary medical center in Taiwan evaluated IVT in patients with confirmed low DOAC concentrations (<100 ng/mL). No symptomatic intracranial hemorrhage was observed among IVT recipients, while a trend toward better functional outcomes was noted compared with DOAC-treated patients who did not receive IVT.
These findings suggest that a concentration-guided approach may help identify DOAC-treated patients who could safely benefit from IVT, potentially avoiding unnecessary treatment exclusion based solely on the timing of the last DOAC dose. Future randomized controlled trials are warranted to validate the safety and efficacy of this strategy and inform clinical practice.
The increasing incidence of atrial fibrillation (AF), together with the widespread adoption of direct oral anticoagulants (DOACs) as first-line therapy for stroke prevention, has substantially shifted anticoagulant prescribing patterns from warfarin toward DOACs. Consequently, the number of patients experiencing acute ischemic stroke (AIS) during DOAC therapy is expected to increase, posing challenges for acute stroke management.
Intravenous thrombolysis (IVT) remains a cornerstone of AIS treatment; however, its use in patients receiving DOACs raises concerns regarding intracranial hemorrhage. The 2026 American Heart Association/American Stroke Association guidelines acknowledge the uncertainty surrounding the safety of IVT in patients with DOAC exposure within the preceding 48 hours. Nevertheless, emerging observational evidence suggests that IVT may be safe in selected patients with DOAC exposure ranging from 48 hours to as long as 7 days before treatment. However, most studies lack DOAC concentration measurements at the time of thrombolysis, limiting the interpretation of these findings.
Our recent study conducted at a tertiary medical center in Taiwan evaluated IVT in patients with confirmed low DOAC concentrations (<100 ng/mL). No symptomatic intracranial hemorrhage was observed among IVT recipients, while a trend toward better functional outcomes was noted compared with DOAC-treated patients who did not receive IVT.
These findings suggest that a concentration-guided approach may help identify DOAC-treated patients who could safely benefit from IVT, potentially avoiding unnecessary treatment exclusion based solely on the timing of the last DOAC dose. Future randomized controlled trials are warranted to validate the safety and efficacy of this strategy and inform clinical practice.
