Results of rapid plasma direct oral anticoagulant levels greatly expand stroke thrombolysis eligibility: evidence from real-world implementation

Abstract

Direct oral anticoagulants (DOACs) are used for stroke prevention in atrial fibrillation, but their presence can limit thrombolysis eligibility in acute stroke. This retrospective study examined whether rapid plasma DOAC testing expanded eligibility for thrombolysis. Among ischaemic stroke patients taking DOACs who were otherwise eligible for thrombolysis, 40% had low DOAC levels (<50 ng/mL). This led to the use of potentially life- and disability-saving thrombolysis in patients who would otherwise have been ineligible.