Lightning Oral Presentation Australian and New Zealand Stroke Organisation Conference 2026

Preferences for Thrombolysis in Patients on Direct Oral Anticoagulants (139608)

Matthew Kaufman 1 , Michael Zhu 1 , Philip Choi 2 3 4
  1. Eastern Health, Box Hill, VIC, Australia
  2. Department of Neuroscience, Eastern Health, Box Hill, VIC, Australia
  3. Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
  4. Victorian Stroke Telemedicine, Ambulance Victoria, Melbourne, VIC, Australia

Background/ Aims:

Current observational evidence suggests that intracranial haemorrhage rates following thrombolysis are comparable between direct oral anticoagulant (DOAC) users and non-users. Despite this, DOAC therapy remains a common clinical contraindication. This study aims to evaluate the preferences of patients on DOACs regarding thrombolysis for acute stroke.

 

Methods:

A cross-sectional survey was conducted among randomly selected hospital inpatients on DOACs to evaluate preferences on thrombolysis for acute ischemic stroke. Baseline knowledge was assessed and participants were subsequently informed of current evidence regarding bleeding risks. Following this, patients indicated their preferences for thrombolysis across four hypothetical stroke severities (mild, moderate, severe, and catastrophic).

 

Results:

Ninety patients (n=90), median age 74.5 (IQR 66-85), 53% male and 47% female, were included in the final analysis.

Participants demonstrated preference for thrombolysis across all hypothetical stroke severities. However, acceptance rates generally decreased as severity increased.

For mild strokes, 71.1% of patients opted for thrombolysis, 14.4% refused, and 14.4% were undecided. For moderate strokes, 75.6% opted for thrombolysis, 11.1% refused, and 13.3% were undecided. For severe strokes, 64.4% opted for thrombolysis, 21.1% refused, and 14.4% were undecided. For catastrophic strokes, 58.9% opted for thrombolysis, 27.8% refused, and 13.3% were undecided.

 

Conclusion:

Despite current clinical practices, this population of patients on DOACs demonstrates a strong preference for receiving thrombolysis. Patient preferences appear to align with emerging observational data suggesting comparable safety for thrombolysis in DOAC users. Our findings support the clinical equipoise that forms the bases for ongoing randomised control trials, including ACT-WHEN and DO-IT.

  1. Ghannam M, AlMajali M, Galecio-Castillo M, Al Qudah A, Khasiyev F, Dibas M, et al. Intravenous Thrombolysis for Acute Ischemic Stroke in Patients With Recent Direct Oral Anticoagulant Use: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2023;12(24):e031669.