Abstract Body: Background and Purpose
Intravenous thrombolysis for acute ischemic stroke (AIS) is a proven effective treatment. Whether thrombolysis in AIS patients with recent direct oral anticoagulant (DOAC) use is safe and efficacious is not well established. We aimed to compare outcomes of patients with AIS and recent DOAC use who received thrombolysis to those otherwise eligible but excluded from thrombolysis due to recent DOAC use.

Methods
This study included patients entered into the Get with the Guidelines (GWTG) registry with a diagnosis of AIS who presented to an acute care facility within 4.5 hours from last known normal, used a DOAC within 7 days before hospital arrival, and either: 1) received intravenous thrombolysis, OR 2) were excluded from thrombolysis with coagulopathy being the only reason for exclusion. We used univariate and adjusted binary logistic regression models with clustering by site to compare the two groups’ functional status (ambulation on discharge and discharge disposition) and reported rates of safety outcomes in the thrombolysis group (symptomatic intracranial hemorrhage, extracranial hemorrhage, and death).

Results
The study sample included 48,907 AIS patients using a DOAC; 4,702 received thrombolysis and 44,205 did not. The mean age was 75.1 years and 50.5% were men. In adjusted logistic regression models, patients with recent DOAC use receiving thrombolysis were more likely to ambulate independently at discharge (OR 1.35, 95% CI 1.21-1.50) and to be discharged home (OR 1.33 95% CI 1.22-1.46). The rate of symptomatic intracranial hemorrhage with intravenous thrombolysis in patients with recent DOAC use was 3.5% (95% CI 3.0%-4.1%).

Conclusions
In this analysis of the GWTG registry, intravenous thrombolysis was associated with improved functional outcomes in patients with recent DOAC use and appeared safe. Given the limitations of our real-world registry analysis, these findings require validation by prospective trials.