Coagulation Testing in Acute Ischemic Stroke Patients Taking Non–Vitamin K Antagonist Oral Anticoagulants

Author:

Purrucker Jan C.1,Haas Kirsten1,Rizos Timolaos1,Khan Shujah1,Poli Sven1,Kraft Peter1,Kleinschnitz Christoph1,Dziewas Rainer1,Binder Andreas1,Palm Frederick1,Jander Sebastian1,Soda Hassan1,Heuschmann Peter U.1,Veltkamp Roland1,Dichgans M.2,Gröschel K.3,Eicke M.4,Ertl M.5,Hennerici M. G.6,Hobohm C.7,Höhle T.8,Jüttler E.9,Khaw A.10,Kraft A.11,Köhrmann M.12,Meisel F.13,Neumann-Haefelin T.14,Opherk C.15,Röther J.16,Schmid E.17,Seidel G.16,Tanislav C.18,Thomalla G.16,Wartenberg K.19,Weimar C.20,

Affiliation:

1. From the Department of Neurology, University Hospital, Heidelberg, Germany (J.C.P., T.R., S.K., R.V.); Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (K.H., P.U.H.); Department of Neurology, University Hospital, Tübingen, Germany (S.P.); Department of Neurology, University Hospital, Würzburg, Germany (P.K., C.K.); Department of Neurology, University Hospital, Essen, Germany (C.K.); Department of Neurology, University Hospital, Münster, Germany (R.D.); Department of...

2. München

3. Mainz

4. Idar-Oberstein

5. Regensburg

6. Mannheim

7. Leipzig

8. Herne

9. Ulm

10. Greifswald

11. Halle

12. Erlangen

13. Karlsruhe

14. Fulda

15. Heilbronn

16. Hamburg

17. Stuttgart

18. Gießen

19. Halle-Wittenberg

20. Essen

Abstract

Background and Purpose— In patients who present with acute ischemic stroke while on treatment with non–vitamin K antagonist oral anticoagulants (NOACs), coagulation testing is necessary to confirm the eligibility for thrombolytic therapy. We evaluated the current use of coagulation testing in routine clinical practice in patients who were on NOAC treatment at the time of acute ischemic stroke. Methods— Prospective multicenter observational RASUNOA registry (Registry of Acute Stroke Under New Oral Anticoagulants; February 2012–2015). Results of locally performed nonspecific (international normalized ratio, activated partial thromboplastin time, and thrombin time) and specific (antifactor Xa tests, hemoclot assay) coagulation tests were documented. The implications of test results for thrombolysis decision-making were explored. Results— In the 290 patients enrolled, nonspecific coagulation tests were performed in ≥95% and specific coagulation tests in 26.9% of patients. Normal values of activated partial thromboplastin time and international normalized ratio did not reliably rule out peak drug levels at the time of the diagnostic tests (false-negative rates 11%–44% [95% confidence interval 1%–69%]). Twelve percent of patients apparently failed to take the prescribed NOAC prior to the acute event. Only 5.7% (9/159) of patients in the 4.5-hour time window received thrombolysis, and NOAC treatment was documented as main reason for not administering thrombolysis in 52.7% (79/150) of patients. Conclusions— NOAC treatment currently poses a significant barrier to thrombolysis in ischemic stroke. Because nonspecific coagulation test results within normal range have a high false-negative rate for detection of relevant drug concentrations, rapid drug-specific tests for thrombolysis decision-making should be established. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01850797.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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