Would you administer IV thrombolysis in a patient presenting with disabling stroke symptoms while on anti-amyloid therapy?

I agree with @Dr. First Last. There seems to be one case of catastrophic bleeding in the published literature. However, such events can occur with thrombolysis alone or in the context of other cerebrovascular conditions such as CAA, vascular malformations, and even severe WMH. While it's important t...

I would attempt to ascertain whether the patient's past MRI revealed evidence of amyloid angiopathy. If this information is unavailable, obtaining a stat MRI may be justified. I would not exclude the patient solely based on being on anti-amyloid therapy.

While we should be cautious about basing decisions solely on the findings of a single case report, such as the one describing cerebral hemorrhages after thrombolysis in a patient on lecanemab therapy (Reish et al., PMID 36599061), the "Lecanemab: Appropriate Use Recommendations" by the Alzheimer's D...

Most hospitals have rapid stroke MRI 4 sequence protocol which hardly takes 15 minutes or less. It's better to get that done if the patient has been on lecanemab before. Based on that and the CMB burden, one can clinically decide if they want to go ahead with IV thrombolysis which I imagine will dif...