Intravenous Thrombolysis in a Stroke Patient Receiving Rivaroxaban

Rivaroxaban, a novel direct factor Xa inhibitor with consistent anticoagulant properties, was found to be safer and equally effective as warfarin in the prevention of embolic stroke in patients with nonvalvular atrial fibrillation [1, 2] . Effective anticoagulation predisposes to bleeding and represents a contraindication for intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rtPA), the only approved therapy for acute ischemic stroke [3] . However, the clinical outcome and the risk of symptomatic intracranial hemorrhage (ICH) after IVT in stroke patients treated with rivaroxaban have so far been unknown.