Supplementary Material for: Estimating the Quantitative Demand of NOAC Antidote Doses on Stroke Units

Background: The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit. Methods: We extracted data of patients with acute ischemic stroke and ICH (Results: Eighteen percent of ICH patients within 6 h of symptom onset or an unknown symptom onset were on OAT. Given a NOAC share at admission of 40%, about 7% of all ICH patients may qualify for NOAC reversal therapy. Thirteen percent of ischemic stroke patients admitted within 4 h presented on anticoagulation. Given the availability of an appropriate antidote, a NOAC share of 50% could lead to a 6.1% increase in thrombolysis rate. Conclusions:Stroke units serving populations with a comparable demographic structure should prepare to treat up to 1% of all acute ischemic stroke patients and 7% of all acute ICH patients with NOAC antidotes. These numbers may increase with the mounting prevalence of atrial fibrillation and an increasing use of NOAC.

背景：非维生素K拮抗剂口服抗凝剂（non-vitamin K antagonist oral anticoagulants, NOAC）的首款特异性解毒剂近日已获批上市。此类NOAC解毒剂可为两类迄今棘手的患者群体提供针对性治疗：一是接受口服抗凝治疗（oral anticoagulant therapy, OAT）相关脑出血（intracerebral hemorrhage, ICH）的患者，二是需接受溶栓治疗且正服用口服抗凝药物的患者。本研究旨在评估此类事件的发生频率，进而估算卒中单元内解毒剂的定量需求量。方法：本研究提取了急性缺血性脑卒中及脑出血患者的临床数据。结果：发病6小时内或发病时间不明的脑出血患者中，18%正在接受口服抗凝治疗。若入院患者中NOAC的占比为40%，则约7%的脑出血患者符合NOAC逆转治疗的指征。发病4小时内入院的缺血性脑卒中患者中，13%正接受抗凝治疗。若有合适的解毒剂可供使用，且NOAC的临床占比达50%，则溶栓治疗率可提升6.1%。结论：服务人口结构相似的卒中单元应做好储备准备，可为约1%的急性缺血性脑卒中患者及7%的急性脑出血患者提供NOAC解毒剂治疗。随着心房颤动患病率持续攀升以及NOAC临床应用日益广泛，此类治疗需求或进一步增加。