Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Is thrombolysis safe in anticoagulated ischaemic stroke?

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

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 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).

    Article  PubMed  Google Scholar 

  2. European Stroke Organisation (ESO) Executive Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc. Dis. 25, 457–507 (2008).

  3. Mazya, M. V. et al. Safety of IV thrombolysis for ischemic stroke in patients treated with warfarin. Ann. Neurol.

  4. 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).

    Google Scholar 

  5. 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).

    CAS  Article  PubMed  Google Scholar 

  6. Frank, B. et al. Thrombolysis in stroke despite contraindications or warnings? Stroke 44, 727–733 (2013).

    CAS  Article  PubMed  Google Scholar 

  7. Rizos, T. et al. Oral anticoagulants—a frequent challenge for the emergency management of acute ischemic stroke. Cerebrovasc. Dis. 34, 411–418 (2012).

    CAS  Article  PubMed  Google Scholar 

  8. Gladstone. et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke 40, 235–240 (2009).

    CAS  Article  PubMed  Google Scholar 

  9. 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).

    CAS  Article  PubMed  Google Scholar 

  10. 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).

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Roland Veltkamp.

Ethics declarations

Competing interests

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.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Veltkamp, R., Rizos, T. Is thrombolysis safe in anticoagulated ischaemic stroke?. Nat Rev Neurol 9, 492–493 (2013).

Download citation

  • Published:

  • Issue Date:

  • DOI:


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing