Speaker(s): 

Lamees Alhallaq, MD, Resident Physician, Geisinger - has nothing to disclose.

Moderator(s):

Varun Pulakanti, MD, Physician Neurohospitalist, Geisinger - has nothing to disclose

Learning Objectives:

1. Assess the risk of symptomatic intracranial hemorrhage (sICH) in patients undergoing intravenous thrombolysis (IVT) with recent direct oral anticoagulant (DOAC) use compared to non-anticoagulated controls
2. Discuss the implications of this study on current IVT guidelines and whether recent DOAC ingestion should remain a contraindication for thrombolysis 
3. Evaluate the safety and efficacy of different selection strategies for IVT in DOAC users, including plasma level measurement, reversal therapy, and empirical thrombolysis 

At the conclusion of this session, the participant should be able to answer the following questions:

1. Given the study's findings, should guidelines updated to remove the 48-hour exclusion rule for IVT in patients with recent DOAC ingestion? Why or why not?
2. What factors might contribute to the lower rate of sICH observed in DOAC users compared to the control group, despite theoretical concerns about hemorrhagic risk?
3. How might this study influence decision-making in emergency stroke management, particularly in centers without immediate access to DOAC-level measurements?

Disclosure of Relevant Financial Relationships with/without Commercial Interests:

The Planning Committee consisting of Dana Vanino, DO, Cortney Houtz, LPN, Joy Hill, RN, and Kristy Heim have no identified disclosures. 

CE Committee Member/Content Reviewers have nothing to disclose. 

Any/All relevant financial relationships have been mitigated. 

Content Disclosure: 

This presentation/content is HIPAA compliant. 

Commercial Support for this Session

None