Thrombectomy on DOAC — EECC MCQ

Correct answer: C — DOAC use is NOT a contraindication to mechanical thrombectomy — unlike IV thrombolysis (which requires DOAC reversal or subtherapeutic drug levels), thrombectomy does not carry the same haemorrhagic risk from anticoagulation and can proceed directly

Mechanical thrombectomy for large vessel occlusion acute ischaemic stroke is a catheter-based procedure (stent retriever or aspiration) that directly removes the occluding thrombus. Unlike IV thrombolysis, it does not involve systemic fibrinolysis and therefore: (1) DOAC status is NOT a contraindication; (2) no DOAC reversal is needed before thrombectomy; (3) the procedure can be performed regardless of anticoagulation status. This is clinically important because: (1) many AF patients on DOACs present with stroke from LAA thromboembolism; (2) IV thrombolysis is contraindicated with therapeutic DOAC levels (unless reversed); (3) thrombectomy provides an alternative reperfusion strategy. The ESC 2024 AF Guidelines and AHA/ASA stroke guidelines recommend proceeding directly to thrombectomy when a large vessel occlusion is identified, without delay for anticoagulation assessment.

Reference: ESC (2024): AF Guidelines; AHA/ASA Stroke Guidelines