Reperfusion Therapy – NOACs and thrombolysis

The Royal College of Physicians recommend that patients taking a NOAC (novel oral anticoagulant) should be excluded from receiving alteplase [1].

The only exception is for patients on dabigatran (Pradaxa ). The RCP suggest that if the prothrombin time and activated partial thromboplastin time are both normal, thrombolysis can be considered for these patients. You should discuss this with your local clinical lead for stroke.

The use of reversal agents (idarucizumab or andexanet alfa) in order to then administer alteplase for an ischaemic stroke that has occurred during NOAC treatment is not recommended