Accidental Thrombolysis in a Stroke Patient Receiving Apixaban

Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is contraindicated in stroke patients receiving oral anticoagulants [1] . Knowledge of current medication is therefore necessary before commencing IVT. In the emergency setting, pointof-care (POC) coagulation devices provide rapid international normalized ratio (INR) measurements [2] . However, current POC devices that are used to monitor vitamin K antagonists are not always suitable for accurately measuring anticoagulant activity of the new oral anticoagulants (NOACs) [3] . We report an ‘accidental’ thrombolysis in a stroke patient in whom treatment with apixaban, a NOAC that inhibits factor Xa (FXa), became apparent only after the completion of IVT.