title: Management of acute stroke in patients taking novel oral anticoagulants.
abstract: Each year, 1·0-2·0% of individuals with atrial fibrillation and 0·1-0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2-0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offers practical approaches to the management of patients receiving novel oral anticoagulants who present with an ischemic or hemorrhagic stroke. Specifically, we discuss the role of thrombolysis in anticoagulated patients with acute ischemic stroke and factors to consider concerning restarting anticoagulation after acute ischemic and hemorrhagic stroke.
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steiner
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000188:drug therapy; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D000925:Anticoagulants
keywords: acute stroke; anticoagulants; intracerebral hemorrhage; secondary prevention; thrombolytic therapy