Speaker(s): 

Harsh Desai, MD, Fellow at Geisinger - has nothing to disclose.

Mentor is Dr. Varun Pulakanti

Learning Objectives

• Discuss the safety profile of off-label intravenous thrombolysis (IVT) in acute ischemic stroke patients with recent direct oral anticoagulant (DOAC) intake​
• Evaluate the efficacy outcomes of IVT in DOAC patients compared to those not receiving IVT using target trial methodology​
• Assess the role of DOAC reversal with idarucizumab prior to IVT and its impact on safety and functional outcomes​

Disclosure of Relevant Financial Relationships with/without Commercial Interests:

The Planning Committee consisting of Anthony Noto, MD, David Ermak, DO, Lisa Wasko, BSN, RN, SCRN 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

1. Please see my follow up questions below: 
   1. Given the significant indication bias in this study (IVT patients had lower NIHSS, fewer LVOs, fewer comorbidities),
      how confident are you in the efficacy findings? Would you change your practice based on these results?​
   2. This study found that DOAC plasma levels and time from last intake were NOT predictive of sICH in IVT-treated patients. Does this challenge your current approach to checking DOAC levels before thrombolysis? Should we still obtain them?
   3. The benefit of IVT was only seen in "liberal" centers (those giving IVT to >20% of DOAC patients). What factors do you think drive appropriate patient selection for IVT in the DOAC population? How would you apply this at our institution?