Comparing Safety of TNK-Based IVT vs rt-PA in DOAC-Exposed AIS Patients

Background: Guidelines often discourage IV thrombolysis (IVT) in acute ischemic stroke (AIS) with recent direct oral anticoagulant (DOAC) intake, but emerging real-world data (mostly alteplase [rt-PA]) suggest bleeding risk may not be markedly increased. Evidence for tenecteplase (TNK) in this setting is sparse. Objective: To compare safety (especially symptomatic intracranial hemorrhage [sICH]) and in-hospital outcomes of TNK versus rt-PA IVT in DOAC-treated AIS patients when IVT is given without prior. Design: Retrospective single-center registry (University Hospital Erlangen, Germany) conducted from March 2023 to June 2025; groups reflected an institutional switch from rt-PA (until March 2024) to TNK. Participants: 82 AIS patients with reported DOAC intake within 48 hours who received IVT (TNK, 42; rt-PA, 40). Median age was 83 (TNK) vs 82 years; median admission National Institutes of Health Stroke Scale (NIHSS) score was 9 in both. TNK patients had higher heart failure (28.6% vs more...