Would you consider off-label IV thrombolysis in patients taking a DOAC and presenting with disabling acute ischemic stroke within the window?

Addendum: Re- access to serum concentration for the DOAC.

Yes - access to serum concentration for the DOAC, like factor Xa levels, for example, for Eliquis and Xarelto, or ECT for dabigatran, does change my management. In those with normal levels of specific anticoagulation tests, I would discuss IV...

In brief, yes, I would and do consider it. I have both treated patients deliberately and inadvertently who were on DOACs (and who took medication in the last 24-hours). When it was inadvertent, I simply did not know and could not know (aphasic patient, no record available, no corroborative informati...

This is a difficult question to answer. I would, in certain circumstances, such as a younger patient without comorbidities that increase bleeding risk. Also, if the patient had a prior MRI that did not show microbleeds, that would be helpful. I would also make the patient and their family aware of t...

I would NOT. In general, because thrombolysis carries a significant hemorrhage risk, you have to be very careful when using it. This is why the thrombolysis studies excluded patients with higher hemorrhage risk. Also, we must not forget that there are other treatments apart from acute therapy. Most ...

I agree more completely with Dr. @Dr. First Last. We had a case in our institution where a non-stroke specialist covering stroke telemedicine advised tPA in a patient on rivaroxaban, and the patient had a fatal bleed. Hence, I would advise caution and full information to the patient/family before gi...