Risk of study-defined symptomatic intracranial haemorrhage after acute ischaemic stroke reperfusion therapy in the setting of anticoagulation use
| Anticoagulation Use Reference name (number) (sICH timing) | Reperfusion type | Effect estimate (95% CI)* |
| Jin et al, 201824(<0.5–7 days) | ||
| DOACs | Intravenous rtPA | Rate 4.3%(2.7 to 6.4) |
| Dabigatran without Ida. reversal | Intravenous rtPA | Rate 7.4%(3.5 to 13.4) |
| Dabigatran with Ida. reversal | Intravenous rtPA | Rate 4.5%(0.8 to 13.4) |
| Dabigatran w/ versus w/o Ida. reversal | Intravenous rtPA | OR 0.60 (0.12 to 2.92) |
| Xian et al, 201741(<36 hour) | ||
| DOACs | Intravenous rtPA | Rate 4.8% |
| DOACs versus no DOACs | Intravenous rtPA | OR 0.92 (0.51 to 1.65) |
| Warfarin (INR<1.7) | Intravenous rtPA | Rate 4.9% |
| Warfarin (INR<1.7) versus no warfarin | Intravenous rtPA | OR 0.85 (0.66 to 1.10) |
| Cooray et al, 201942(<7 d) | ||
| LMW Heparin versus no LMWH | Intravenous rtPA | Rate 3.1% vs 4.2% |
| Rebello et al, 201525(<7 d) | ||
| OACs versus no OACs | ET | Rate 8% vs 5% |
| OACs versus no OACs+intravenous rtPA | ET | Rate 8% vs 4% |
| VKA versus DOACs | ET | Rate 9.2% vs 6.8% |
| Meinel et al, 202028(22 h-36h or<7 d) | ||
| VKAs versus no VKAs | ET | OR 1.62† (1.22 to 2.17) |
| DOACs versus no DOACs | ET | OR 1.03 (0.60 to 1.80) |
| Seiffge et al, 201543 (<7 days) | ||
| DOACs | intravenous rtPA and/or ET | Rate 3.2% |
| VKAs (all INRs) | intravenous rtPA and/or ET | Rate 6.1% |
| DOACs | intravenous rtPA | Rate 4% |
| VKAs (all INRs) | intravenous rtPA | Rate 3.6% |
| --VKAs+INR ≤ 1.7 | intravenous rtPA and/or ET | Rate 4.7% |
| --VKAs+INR >1.7 | intravenous rtPA and/or ET | Rate 11.2% |
*CIs were not reported for all studies
†Denotes statistical significance under the p<0.05 assumption
DOAC, direct oral anticoagulant (eg, dabigatran, rivaroxaban, apixaban, edoxaban); ET, endovascular therapy; Ida., idarucizumab; INR, international normalised ratio; LMWH, low molecular weight heparin; OAC, any oral anticoagulant (VKA and/or DOAC); rtPA, tissue plasminogen activator; VKA, vitamin K antagonist anticoagulant.