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DOAC Reversal for Stroke Thrombolysis — EECC MCQ

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HardCardiac PharmacologyDOAC Reversal for Stroke ThrombolysisEECC

A patient presents 90 minutes after disabling ischaemic stroke while taking apixaban. The last dose was 4 hours ago and renal function is normal. CT excludes haemorrhage and a proximal large-vessel occlusion is present. What is the best reperfusion approach?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Prioritise thrombectomy and usually omit thrombolysis

Recent therapeutic apixaban generally excludes routine intravenous thrombolysis because of intracranial bleeding risk, and reversal with andexanet followed by lysis is not an established standard pathway. A proximal occlusion remains an indication for immediate thrombectomy assessment, which should not be delayed while pursuing an unsafe drug sequence. Some centres use calibrated anti-Xa testing within a protocol, but a normal conventional coagulation screen is insufficient. Exact decisions require the local stroke and interventional neuroradiology pathway.

Reference: NICE NG128: stroke and transient ischaemic attack in over 16s. https://www.nice.org.uk/guidance/ng128/chapter/recommendations