Senta Frol, MD, PhD, University Medical Centre Ljubljana, Ljubljana, Slovenia, debates if reversal agents should be used to allow intravenous thrombolysis (IVT) to be given to patients with acute ischemic stroke who are taking direct oral anticoagulants (DOAC). Although DOACs are very effective in preventing stroke in people with atrial fibrillation, ischemic strokes still occur. Typically, IVT is contraindicated in people who are anticoagulated. Rapidly acting reversal agents are now available for DOACs which raises the possibility that these could be used before IVT. However, evidence is limited, and guidelines contain heterogenous recommendations. Based on various studies, including real-world data, reversal of dabigatran anticoagulation activity using idarucizumab is recommended. In contrast, andexanet alfa for the reversal of factor Xa inhibitor activity should not be used before IVT in patients with ischemic stroke. This interview took place at the 17th World Congress on Controversies in Neurology (CONy) in Dubrovnik, Croatia.
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