Abstract Number: Esoc2026a1252 Intravenous Thrombolysis in Acute Ischemic Stroke Patients on Direct Oral Anticoagulants Undergoing Endovascular Thrombectomy

Background and aims The necessity of bridging endovascular thrombectomy (EVT) with intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) has been questioned. Recent observational studies suggest that IVT is safe in AIS patients on direct oral anticoagulants (DOAC). We aimed to investigate the risk-benefit of bridging therapy in AIS patients on DOAC. Methods We used the SITS international Treatment registry to include AIS patients on DOAC that received EVT. We compared bridging therapy with EVT alone using propensity score matching (PSM). Primary outcome was 3-month functional independency (modified Rankin scale 0-2). Secondary outcomes were symptomatic intracerebral hemorrhage (SICH) per SITS-MOST definition and death by 3 months. We performed explorative multivariate regression of quadratically modelled imaging-to-groin time, investigating any cut-offs for functional independence. Results Of 1,991 DOAC treated EVT patients, 317 received IVT. After PSM, we included 294 bridging therapy patients and 587 EVT only patients. After PSM, the groups were well balanced for baseline and demographic characteristics (median NIHSS 17 vs. 16, age 76 and onset to imaging time 99 min in both groups). There were no statistically significant differences in functional independence (36% vs. 35%), SICH (1.5% vs. 2.2%) and mortality (34% vs. 30%) between bridging and EVT only. Explorative analyses found imaging-to-groin time within 66 min favors EVT only while imaging-to-groin time beyond 185 min favors bridging. Conclusions We found no differences in safety and outcomes between bridging therapy and EVT only in AIS patients on DOAC. Explorative analyses suggesting shorter imaging-to-groin times favor direct EVT while longer times favor bridging.