Abstract Body: BACKGROUND: Despite the increasing use of intravenous (IV) tenecteplase (TNKase) for acute ischemic stroke (AIS), little is known about the characteristics of patients who suffer intracerebral hemorrhage (ICH) and opportunities to prevent this often-fatal complication. PURPOSE: The aim of this retrospective review was to investigate the characteristics of AIS patients with ICH complication and opportunities in patient management after receiving IV TNKase in the emergency departments (EDs) and to report preliminary results. METHODS: Retrospectively, the EHRs that suffered ICH complication after receiving TNKase (0.25 mg/kg) were reviewed from 21 hospitals in a large integrated health system between November 2020 to December 2023. Data collection included demographics, risk factors, blood pressures (BPs), and other variables such as the National Institute of Health Stroke Score (NIHSS), presence and types of large vessel occlusion, and severity of the hemorrhage (symptomatic or asymptomatic). RESULTS: The mean age of the 195 cases was 75.4 (SD = 13.46). There were no sex differences (p=.87). Race breakdown was 50% (n = 98) Whites; 15% (n = 98) Hispanics/Latinos; 20% (n = 39) Asians, and 10% (n = 20) Blacks. Majority of patients (73%) arrived via EMS. History of was present in 75.4% of patients, followed by diabetes (58%), hyperlipidemia (55%), atrial fibrillation (20%), and history of stroke (18%). Anti-coagulants use was 8% (n=17). The initial mean NIHSS in the ED was 11.8 (SD=8.65). On initial presentation, the mean systolic and diastolic BPs was 164 (SD=27.1) and 90 (SD=19.46) respectively. Large vessel occlusions (LVOs) were identified in 35.9% (n=70) of patients. Of the LVO cases (n=70), 68.6% (n=48) of the ICH were asymptomatic. CONCLUSIONS: Based on the preliminary results, there were some patient-level risk factors that may have contributed to ICH complications after IV TNKase. Tighter control of BPs with anti-hypertensives before and after IV TNKase may also decrease bleeding risk. There were a few opportunities identified with patient assessment and monitoring. The use of both “full” NIHSS and abbreviated NIHSS varied between facilities, which may have delayed the identification of post-TNKase ICH as the abbreviated NIHSS did not provide a total score to assess for change in patient condition and about 40% of patients did not have an increase in the NIHSS. In-depth data reviews and analysis would be necessary to ascertain clinical significance.