title: Estimating the Quantitative Demand of NOAC Antidote Doses on Stroke Units.
abstract: The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit.
  
  
  
  We extracted data of patients with acute ischemic stroke and ICH (<24 h after symptom onset) in the years 2012-2015 from a state-wide prospective stroke inpatient registry. We selected 8 stroke units and determined the mode of OAT upon admission in 2012-2013. In 2015, the mode of OAT became a mandatory item of the inpatient registry. From the number of anticoagulated patients and the NOAC share, we estimated the current and future demand for NOAC antidote doses on stroke units.
  
  
  
  Eighteen percent of ICH patients within 6 h of symptom onset or an unknown symptom onset were on OAT. Given a NOAC share at admission of 40%, about 7% of all ICH patients may qualify for NOAC reversal therapy. Thirteen percent of ischemic stroke patients admitted within 4 h presented on anticoagulation. Given the availability of an appropriate antidote, a NOAC share of 50% could lead to a 6.1% increase in thrombolysis rate.
  
  
  
  Stroke units serving populations with a comparable demographic structure should prepare to treat up to 1% of all acute ischemic stroke patients and 7% of all acute ICH patients with NOAC antidotes. These numbers may increase with the mounting prevalence of atrial fibrillation and an increasing use of NOAC.
authors.affiliation: Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Waltraud
authors.initials: W
authors.lastname: Pfeilschifter
authors.forename: Dana
authors.initials: D
authors.lastname: Farahmand
authors.forename: Daniela
authors.initials: D
authors.lastname: Niemann
authors.forename: Benno
authors.initials: B
authors.lastname: Ikenberg
authors.forename: Carina
authors.initials: C
authors.lastname: Hohmann
authors.forename: Mario
authors.initials: M
authors.lastname: Abruscato
authors.forename: Sven
authors.initials: S
authors.lastname: Thonke
authors.forename: Adam
authors.initials: A
authors.lastname: Strzelczyk
authors.forename: Günther
authors.initials: G
authors.lastname: Hedtmann
authors.forename: Tobias
authors.initials: T
authors.lastname: Neumann-Haefelin
authors.forename: Rainer
authors.initials: R
authors.lastname: Kollmar
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Singer
authors.forename: Andreas
authors.initials: A
authors.lastname: Ferbert
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steiner
authors.forename: Helmuth
authors.initials: H
authors.lastname: Steinmetz
authors.forename: Anke
authors.initials: A
authors.lastname: Reihs
authors.forename: Björn
authors.initials: B
authors.lastname: Misselwitz
authors.forename: Christian
authors.initials: C
authors.lastname: Foerch
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D000931:Antidotes / Q000600:supply & distribution*; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005544:Forecasting; D005858:Germany; D006301:Health Services Needs and Demand / Q000639:trends; D006757:Hospital Units / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000639:trends; D012042:Registries; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D000931:Antidotes