Recanalization Therapy for Acute Stroke in the Setting of Oral Anticoagulation
A 76-year-old woman with atrial fibrillation (AF), remote inferior myocardial infarction, hypertension, hyperlipidemia, and type 2 diabetes mellitus is brought by ambulance to the Emergency Department after the acute onset of right-sided hemiparesis. She had been well until two hours prior to presentation, at which time she developed slurred speech and right-sided weakness. She is taking apixaban, aspirin, metoprolol, lisinopril, atorvastatin, and metformin. On presentation, she has a temperature of 98.3° F, heart rate of 94 bpm, blood pressure of 143/79 mm Hg, respiratory rate of 16 breaths per minute, and oxygen saturation of 99% on 2 L supplemental oxygen via nasal cannulae. Examination reveals mild dysarthria and right hemiparesis with National Institutes of Health Stroke Scale of 11. Non-contrast head computed tomography shows hypoattenuation involving less than one third of the left main coronary artery territory with no evidence of hemorrhage. The international normalized ratio (INR) is 1.2 and the partial thromboplastin time is 32.6 seconds. The creatinine is 0.78 mg/dL.
Which of the following statements regarding the use of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in the setting of acute ischemic stroke is correct?