Intracerebral haemorrhage is the most serious complication of intravenous thrombolysis in ischaemic stroke, and whether thrombolysis can be performed in patients receiving anticoagulants is an unresolved issue. Data from a large European registry now confirms that thrombolysis in some patients receiving warfarin is as safe as in non-anticoagulated patients.
This is a preview of subscription content
Subscribe to Journal
Get full journal access for 1 year
only $4.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Adams, H. P. et al. Guidelines for the Early Management of Adults with Ischemic Stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke 38, 1655–1711 (2007).
European Stroke Organisation (ESO) Executive Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc. Dis. 25, 457–507 (2008).
Mazya, M. V. et al. Safety of IV thrombolysis for ischemic stroke in patients treated with warfarin. Ann. Neurol. http://doi.dx.org/10.1002/ana.23924.
Xiang, Y. et al. Risks of intracranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated with intravenous tissue plasminogen activator. JAMA 307, 2600–2608 (2012).
Diener, H. C. et al. Treatment of acute ischaemic stroke with thrombolysis or thrombectomy in patients receiving anti-thrombotic treatment. Lancet Neurol. 12, 677–688 (2013).
Frank, B. et al. Thrombolysis in stroke despite contraindications or warnings? Stroke 44, 727–733 (2013).
Rizos, T. et al. Oral anticoagulants—a frequent challenge for the emergency management of acute ischemic stroke. Cerebrovasc. Dis. 34, 411–418 (2012).
Gladstone. et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke 40, 235–240 (2009).
Rizos, T. et al. Point-of-care international normalized ratio testing accelerates thrombolysis in patients with acute ischemic stroke using oral anticoagulants. Stroke 40, 3547–3551 (2009).
Sun, L., Zhou, W., Ploen, R., Zorn, M. & Veltkamp, R. Anticoagulation with dabigatran does not increase secondary intracerebral haemorrhage after thrombolysis in experimental cerebral ischaemia. Thromb. Haemost. 110, 153–161 (2013).
R. Veltkamp has received consulting fees from Boehringer Ingelheim, Bayer, BMS/Pfizer and Roche; research support from Bayer and Boehringer Ingelheim; and speaker's honoraria from Bayer, Boehringer Ingelheim, BMS/Pfizer, Roche, Apoplex Medical Technologies and CSL Behring. T. Rizos declares no competing interests.
About this article
Cite this article
Veltkamp, R., Rizos, T. Is thrombolysis safe in anticoagulated ischaemic stroke?. Nat Rev Neurol 9, 492–493 (2013). https://doi.org/10.1038/nrneurol.2013.159