skip to main content

Stroke on DOAC – Thrombolysis — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardCerebrovascular DiseaseStroke on DOAC – ThrombolysisSCE Neurology

A 58-year-old taking rivaroxaban presents 90 minutes after onset of dense left hemiplegia. His last dose was six hours ago; CT excludes haemorrhage and CTA confirms a right M1 occlusion. What is the most appropriate immediate reperfusion approach?

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

Reveal the answer and explanation

Correct answer: E — Urgently proceed to mechanical thrombectomy assessment; do not give routine intravenous thrombolysis while rivaroxaban activity is likely clinically relevant

The National Clinical Guideline for Stroke excludes people taking a direct oral anticoagulant from routine thrombolysis and does not recommend use of a reversal agent solely to permit thrombolysis. It also identifies anticoagulant use as an example of a contraindication to thrombolysis that does not preclude mechanical thrombectomy. Aspirin and heparin are not alternatives to urgent arterial reperfusion.

Reference: National Clinical Guideline for Stroke, acute care: https://www.strokeguideline.org/chapter/acute-care/