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Outcome of Patients Receiving Thrombolytic Therapy While on Rivaroxaban for Nonvalvular Atrial Fibrillation (from Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).

Publication ,  Journal Article
Chen, ST; Hellkamp, AS; Becker, RC; Berkowitz, SD; Breithardt, G; Fox, KAA; Hacke, W; Halperin, JL; Hankey, GJ; Mahaffey, KW; Nessel, CC ...
Published in: Am J Cardiol
November 15, 2017

The safety of intravenous thrombolysis in patients taking rivaroxaban has not been well established. We retrospectively analyzed the outcomes of all patients who received thrombolytic therapy in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). A review of medical and adverse event records for patients receiving thrombolytic therapy while enrolled in ROCKET AF was performed to determine their baseline characteristics, indications for thrombolysis, and type of agent used. Safety end points were 30-day post-thrombolytic rates of stroke, bleeding, and mortality. A total of 28 patients in ROCKET AF received thrombolytic therapy, with 19 patients on rivaroxaban and 9 patients on warfarin. Ischemic stroke was the most common indication for thrombolysis (n = 10), and alteplase was the most commonly used fibrinolytic agent (n = 14). Of the 19 patients in the rivaroxaban group, there were 2 nonfatal bleeding events and 2 deaths, mostly occurring when thrombolytic therapy was administered within 48 hours of the last rivaroxaban dose. Of the 9 patients in the warfarin group, there was 1 nonfatal bleeding event and 3 deaths, most occurring when thrombolytic therapy was administered outside of 48 hours from the last warfarin dose. In conclusion, these observations suggest that careful assessment of the time since the last dose may be of clinical significance in patients on novel oral anticoagulants who require emergent thrombolysis.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

November 15, 2017

Volume

120

Issue

10

Start / End Page

1837 / 1840

Location

United States

Related Subject Headings

  • Warfarin
  • Vitamin K
  • United States
  • Treatment Outcome
  • Time Factors
  • Thrombolytic Therapy
  • Survival Rate
  • Stroke
  • Rivaroxaban
  • Retrospective Studies
 

Citation

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Chen, S. T., Hellkamp, A. S., Becker, R. C., Berkowitz, S. D., Breithardt, G., Fox, K. A. A., … Patel, M. R. (2017). Outcome of Patients Receiving Thrombolytic Therapy While on Rivaroxaban for Nonvalvular Atrial Fibrillation (from Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation). Am J Cardiol, 120(10), 1837–1840. https://doi.org/10.1016/j.amjcard.2017.07.095
Chen, Sean T., Anne S. Hellkamp, Richard C. Becker, Scott D. Berkowitz, Günter Breithardt, Keith A. A. Fox, Werner Hacke, et al. “Outcome of Patients Receiving Thrombolytic Therapy While on Rivaroxaban for Nonvalvular Atrial Fibrillation (from Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).Am J Cardiol 120, no. 10 (November 15, 2017): 1837–40. https://doi.org/10.1016/j.amjcard.2017.07.095.
Chen ST, Hellkamp AS, Becker RC, Berkowitz SD, Breithardt G, Fox KAA, Hacke W, Halperin JL, Hankey GJ, Mahaffey KW, Nessel CC, Piccini JP, Singer DE, Patel MR. Outcome of Patients Receiving Thrombolytic Therapy While on Rivaroxaban for Nonvalvular Atrial Fibrillation (from Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation). Am J Cardiol. 2017 Nov 15;120(10):1837–1840.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

November 15, 2017

Volume

120

Issue

10

Start / End Page

1837 / 1840

Location

United States

Related Subject Headings

  • Warfarin
  • Vitamin K
  • United States
  • Treatment Outcome
  • Time Factors
  • Thrombolytic Therapy
  • Survival Rate
  • Stroke
  • Rivaroxaban
  • Retrospective Studies