Intravenous Thrombolysis in a Stroke Patient Receiving Rivaroxaban

Fluri, Felix; Heinen, Florian; Kleinschnitz, Christoph

doi:10.1159/000355839

Cited by 17 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Albeit that rivaroxaban was able to counteract pathological thrombus formation in the brain, we did not find evidence of an increased risk of ICH or haemorrhagic transformation of ischaemic tissue. Our observation corroborates findings from other experimental stroke models (26,27) or case reports (28)(29)(30) showing that rivaroxaban does not induce ICH, even after thrombolytic therapy. This is in stark contrast to the situation in rodents on warfarin (27).…”

Section: Discussionsupporting

confidence: 92%

Pretreatment with rivaroxaban attenuates stroke severity in rats by a dual antithrombotic and anti-inflammatory mechanism

Dittmeier¹,

Kraft²,

Schuhmann³

et al. 2016

Thromb Haemost

Self Cite

View full text Add to dashboard Cite

Stroke outcome is more favourable in patients receiving oral anticoagulants compared with non-anticoagulated patients. The reasons for this "stroke-attenuating" property of oral anticoagulants are largely unknown. This study examined whether prestroke anticoagulation with rivaroxaban, a novel direct factor Xa inhibitor, influences stroke severity, thrombin-mediated intracerebral thrombus formation and pro-inflammatory processes in a rat model of brain ischaemia/reperfusion injury. Male Wistar rats were anticoagulated with rivaroxaban and subjected to 90 minutes of transient middle cerebral artery occlusion. Infarct size, functional outcome and the occurrence of intracranial haemorrhage (ICH) were assessed until day 7. Thrombin generation was determined by measuring the amount of thrombin/antithrombin complex. Intracerebral thrombus formation was evaluated by histology and Western blot. CD68-immunoreactivity and the expression of cytokines and adhesion molecules were investigated to assess postischaemic inflammation. The integrity of the blood-brain barrier was analysed using fluorescein isothiocyanate-dextran. Rats pretreated with rivaroxaban developed significantly smaller strokes and less severe functional deficits compared with controls. Although rivaroxaban strongly reduced thrombin-mediated thrombus formation, this was not accompanied by an increased risk of ICH. In addition, rivaroxaban dampened the inflammatory response in the ischaemic brain by downregulating ICAM-1 expression and the activation of CD68+-immune cells. In contrast, rivaroxaban had no effect on the integrity of the blood-brain barrier after stroke. Here, we identified reduced thrombo-inflammation as a major determinant of the stroke-protective property of rivaroxaban in rats. Further studies are needed to assess the therapeutic potential of novel oral anticoagulants in the acute phase after a stroke.

show abstract

Section: Discussionsupporting

confidence: 92%

Pretreatment with rivaroxaban attenuates stroke severity in rats by a dual antithrombotic and anti-inflammatory mechanism

Dittmeier¹,

Kraft²,

Schuhmann³

et al. 2016

Thromb Haemost

Self Cite

View full text Add to dashboard Cite

show abstract

“…3 The decision to use IVT was based on rivaroxaban concentration levels in the calibrated anti-factor Xa assay in 22 of our patients and 2 recent single cases. 19,21 All 24 IVT-treated patients had levels of the calibrated anti-factor Xa assay <100ng/mL. None had sICH but 1 of 24 had an asymptomatic ICH.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] Furthermore, a few case reports on the use of IVT in patients taking dabigatran, [14][15][16][17][18] rivaroxaban, [19][20][21][22] or apixaban, 23 or IAT while taking dabigatran 24 reported favorable clinical outcomes. Conversely, 1 patient with ischemic stroke under dabigatran treatment had a fatal intracranial hemorrhage (ICH) associated with IVT.…”

Section: Clinical Perspective On P 1269mentioning

confidence: 99%

Recanalization Therapies in Acute Ischemic Stroke Patients

et al. 2015

View full text Add to dashboard Cite

Background-We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients withischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results-This is a multicenter cohort pilot study. Primary outcome measures were (1) in no-OAC patients. sICH ECASS-II and sICH NINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences. Conclusions-IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.

show abstract

“…A computerized search in Medline, PubMed and Google Scholar till July 2016, revealed 12 reported cases of IV rtPA given for AIS in patients who were taking ODFXIs, 10 being on Rivaroxaban and 2 being on Apixaban. None of them developed ICH post IV thrombolysis (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Combining our 3 cases with the 12 cases previously reported in the literature, we have 15 AIS patients who were taking ODFXIs within last 48 hours prior to receiving IV rtPA with no ICH.…”

Section: Discussionmentioning

confidence: 72%

Intravenous Thrombolysis for Stroke in Patients Receiving Oral Factor Xa Inhibitors

et al. 2018

View full text Add to dashboard Cite

We present 3 patients who were taking oral direct factor Xa inhibitors (ODFXIs) within 24 hours prior to receiving intravenous recombinant tissue plasminogen activator (IV rtPA) for acute ischemic stroke (AIS). Two patients were on Rivaroxaban (20 mg once daily) and one on Apixaban (2.5 mg twice daily). All 3 received IV rtPA within 3 hours of symptom onset. Their aPPT, PT and INR levels were within normal ranges. They all received the last dose of the ODFXI within the last 24 hours prior to IV rtPA administration. One patient underwent mechanical thrombectomy of a large vessel clot after IV rtPA. None had intracranial hemorrhage (ICH) on 24 hour head CT post IV rtPA. They all had acute infarcts on their brain MRI, diffusion weighted image. Although we had a very low number of patients in our case series, our findings suggest that neither IV rtPA nor the combination of IV rtPA and intra-arterial thrombolysis increases the risk of ICH in AIS patients who are taking ODFXIs and their coagulation parameters are within normal range.

show abstract

Intravenous Thrombolysis in a Stroke Patient Receiving Rivaroxaban

Cited by 17 publications

References 11 publications

Pretreatment with rivaroxaban attenuates stroke severity in rats by a dual antithrombotic and anti-inflammatory mechanism

Pretreatment with rivaroxaban attenuates stroke severity in rats by a dual antithrombotic and anti-inflammatory mechanism

Recanalization Therapies in Acute Ischemic Stroke Patients

Intravenous Thrombolysis for Stroke in Patients Receiving Oral Factor Xa Inhibitors

Contact Info

Product

Resources

About