DOAC Administration

Q: Does a participant need to be rescanned before starting DOAC? A: For this trial we are asking you to follow your standard practice and you should not be doing extra scans for the trial. It a patient is stable then there is not normally a need to rescan.

Q: Should patients stop the usual two weeks of aspirin when they start the DOAC? A: Regarding aspirin we don’t specify this in the protocol so it is at the discretion of the treating clinician. However usual clinical practice would be to stop aspirin on starting DOAC.

Q: Does the DOAC need to be administered 72 hours from stroke onset or hospital admission? A: To ensure the participant receives the DOAC (in the early arm) in time, the patient needs to be randomised and consented ideally within 72 hours and have the DOAC administered with 96 hours. This is a guide only. As long as you can obtain consent and the patient receives the DOAC within 96 hours, then that is fine.

Q: Is it acceptable to crush DOAC tablets for administration through a nasogastric tube? A: DOAC can be administered in any way which is in accordance with their respective SmPCs and local practice and guidance. However, please note that the SmPC for dabigatran warns against crushing or opening capsules.

Q. I know that patient will get randomised to early initiation (i.e. within 4 days [0 - 96 hours] or standard initiation (i.e. between 7-14 days [144 hours – 336 hours] of acute ischaemic stroke onset. But is there an exact timing of when to give it if allocated to any of the group? A: The exact timing of initiating treatment within each group is at the discretion of the treating clinician.

Q: Can the DOAC be given on the same day as Aspirin? A: This is down to individual sites and their local hospital practices. We believe there should be no problems giving both on the same day.

Q: Is it acceptable to crush DOAC tablets for administration through a nasogastric tube? A: DOAC can be administered in any way which is in accordance with their respective SmPCs and local practice and guidance. However, please note that the SmPC for dabigatran warns against crushing or opening capsules.

Q: I know that patient will get randomised to early initiation (i.e. within 4 days [0 - 96 hours] or standard initiation (i.e. between 7-14 days [144 hours – 336 hours] of acute ischaemic stroke onset. But is there an exact timing of when to give it if allocated to any of the group? A: The exact timing of initiating treatment within each group is at the discretion of the treating clinician.