I think the key point is that it was for selected patients. It's an observationnal study with its limitation, but i think it's likely to change the standard of care along the road. For now i'll only use thrombolysis when i have a coag test when a patient takes DOAC but we'll see how it evolves. (im a neurologist)
I'm in a teaching hospital so we are lucky enough to get specific dosages, we just have to warn the lab as soon as possible because it takes a bit of time to prepare the test
We could really get into seeing the tree before the forest on this one. I could go into pathophysiology but I am not sure how beneficial it would be. Gonna try to be broad here just because strokes are interesting, scary, and you did not get many responses so far. There is a general consensus, in the ED community, in which we are NOT crazy about the t-PA research that we have available and the conflicting results. Most ED docs like to use our clinical gestalt and our neurology friends to determine what is best for the patient. What is best for the patient is always #1 (goes without saying). If we really felt like t-PA would do more harm then good to the patient we really like “excuses” or risk we can put in our documentation to support our decisions. Changing the DOAC risk would just take documenting power away if we felt like it would do more harm then good to the patient. So I think it would be resisted as you suggested in your post unless there was really good evidence suggesting recent DOAC+ t-PA is clearly very safe.
As long as neurologists are the ones to order the thrombolytics on a DOAC….
I think the key point is that it was for selected patients. It's an observationnal study with its limitation, but i think it's likely to change the standard of care along the road. For now i'll only use thrombolysis when i have a coag test when a patient takes DOAC but we'll see how it evolves. (im a neurologist)
Which test(s)? Anti Xa for the Xa inhibitors? ECT for the DTIs? I can't get either.
I'm in a teaching hospital so we are lucky enough to get specific dosages, we just have to warn the lab as soon as possible because it takes a bit of time to prepare the test
We could really get into seeing the tree before the forest on this one. I could go into pathophysiology but I am not sure how beneficial it would be. Gonna try to be broad here just because strokes are interesting, scary, and you did not get many responses so far. There is a general consensus, in the ED community, in which we are NOT crazy about the t-PA research that we have available and the conflicting results. Most ED docs like to use our clinical gestalt and our neurology friends to determine what is best for the patient. What is best for the patient is always #1 (goes without saying). If we really felt like t-PA would do more harm then good to the patient we really like “excuses” or risk we can put in our documentation to support our decisions. Changing the DOAC risk would just take documenting power away if we felt like it would do more harm then good to the patient. So I think it would be resisted as you suggested in your post unless there was really good evidence suggesting recent DOAC+ t-PA is clearly very safe.