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Thrombolysis in Direct Oral Anticoagulant–Treated Stroke Patients: Cross-Sectional Survey of Canadian Practice

Year: 2026

Type: article

Abstract: Intravenous thrombolysis for ischemic stroke after recent direct oral anticoagulant (DOAC) ingestion remains controversial due to hemorrhagic risk, limited rapid testing and inconsistent reversal strategies. We conducted an invite-only, web-based cross-sectional survey of Canadian stroke centers using a structured questionnaire. DOAC level testing was inconsistently available, with 9/13 centers (69%) reporting access but 8/13 centers (61%) reporting turnaround times exceeding 30 minutes. Consequently, 9/13 centers (69%) did not routinely use DOAC levels to guide thrombolysis decisions. Current practice demonstrates substantial variability and uncertainty, highlighting important evidence gaps and the potential role of clinical trials and consensus guideline development.

Source: Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques

DOI: 10.1017/cjn.2026.10565

Authors: Seyed Mojtaba Hosseini, Aravind Ganesh, Mohammed A. Almekhlafi, Bijoy K. Menon, Nishita Singh

Institutions: University of Manitoba, University of Calgary

Language: English

Topic: Acute Ischemic Stroke Management

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,550