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May 8, 2026European Stroke JournalOpen Access

Bridging IVT is linked to similar functional independence as EVT alone in DOAC-treated AIS.

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Why the study?

The necessity of bridging EVT with IVT in AIS has been questioned, though recent studies suggest IVT is safe in patients on DOAC.

Does bridging therapy with intravenous thrombolysis improve 3-month functional independency in acute ischemic stroke patients on DOACs undergoing endovascular thrombectomy?

Comparison

Bridging therapy (IVT with EVT) vs EVT alone

Design

Registry-based propensity score matched study

Follow-up

3 months

Key result

Bridging therapy with intravenous thrombolysis prior to endovascular thrombectomy resulted in similar 3-month functional independence compared to EVT alone (36% vs. 35%) in AIS patients on DOACs.

Authors

MMMarius MatuseviciusKarolinska University HospitalANAna Paiva NunesDefense Information Systems AgencyAZAndrea ZiniIstituto delle Scienze Neurologiche di Bologna

Discussion

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Overview

IVT bridging appears safe without outcome benefit in DOAC patients undergoing EVT; leaves open net value pending RCTs.

Key Points

  • This research investigates the effectiveness and safety of bridging intravenous thrombolysis with endovascular thrombectomy in ischemic stroke patients taking direct oral anticoagulants.
  • Utilized the SITS international Treatment registry to include AIS patients on DOAC who received EVT.
  • Compared outcomes of bridging therapy versus EVT only using propensity score matching (PSM).
  • Analyzed primary outcomes of functional independence and secondary outcomes of symptomatic intracerebral hemorrhage and mortality.
  • No significant differences in functional independence (36% vs. 35%), SICH (1.5% vs. 2.2%), and mortality (34% vs. 30%) between bridging and EVT only patients post-PSM.
  • Explorative analyses suggest shorter imaging-to-groin times (≤66 min) favor direct EVT while longer times (>185 min) favor bridging.

Study Design

Type

Observational (n=1,991)

Multicenter

Yes

Structured PICO

Does bridging therapy with intravenous thrombolysis improve 3-month functional independency in acute ischemic stroke patients on DOACs undergoing endovascular thrombectomy?

P
Population
1,991 acute ischemic stroke (AIS) patients on direct oral anticoagulants (DOAC) undergoing endovascular thrombectomy (EVT) from the SITS international Treatment registry. Propensity score matched cohort included 881 patients (median age 76, median NIHSS 16-17).
I
Intervention
Bridging therapy (intravenous thrombolysis prior to endovascular thrombectomy)
C
Comparator
Endovascular thrombectomy (EVT) alone
O
Outcome
3-month functional independency (modified Rankin scale 0-2)hard clinical

Main Result

Absolute Event Rate: 36% vs 35%

In acute ischemic stroke patients on DOACs, bridging intravenous thrombolysis before endovascular thrombectomy appears safe and yields similar functional outcomes compared to EVT alone.

Cite This Study

Matusevicius et al. (2026) conducted an observational in Acute ischemic stroke (n=1,991). Intravenous thrombolysis (bridging therapy) vs. Endovascular thrombectomy alone was evaluated on 3-month functional independency (modified Rankin scale 0-2). Bridging therapy with intravenous thrombolysis prior to endovascular thrombectomy resulted in similar 3-month functional independence compared to EVT alone (36% vs. 35%) in AIS patients on DOACs.

synapsesocial.com/papers/69fd7eb0bfa21ec5bbf06ec8https://doi.org/10.1093/esj/aakag023.613
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Also Consider

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  1. 1ABSTRACT NUMBER: ESOC2026A1415 INTRAVENOUS THROMBOLYSIS PLUS ENDOVASCULAR TREATMENT VERSUS ENDOVASCULAR TREATMENT ALONE IN ACUTE ISCHAEMIC STROKE PATIENTS PRESENTING AT PRIMARY STROKE CENTERS: A SYSTEMATIC REVIEW AND META-ANALYSIS2026
  2. 2ABSTRACT NUMBER: ESOC2026A699 ROLE OF THROMBECTOMY TECHNIQUE IN BRIDGING INTRAVENOUS THROMBOLYSIS FOR BASILAR ARTERY OCCLUSION2026
  3. 3ABSTRACT NUMBER: ESOC2026A1311 BRIDGING THERAPY VERSUS DIRECT THROMBECTOMY IN CARDIOEMBOLIC ACUTE ISCHEMIC STROKE PATIENTS WITH MIDDLE CEREBRAL ARTERY OCCLUSION2026
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  5. 5ABSTRACT NUMBER: ESOC2026A2425 TIMING AS A KEY DETERMINANT OF INTRAVENOUS THROMBOLYSIS BRIDGING THERAPY BEFORE ENDOVASCULAR THROMBECTOMY – A MULTICENTER COHORT STUDY FROM THE EVATRISP COLLABORATION2026