LAUSR

Key Points Question Is the recent use of direct oral anticoagulants (confirmed ingestion within 48 hours) associated with increased risk of symptomatic intracranial hemorrhage following intravenous thrombolysis for ischemic stroke? Findings In this cohort study including 33 207 patients with ischemic stroke who received intravenous thrombolysis at 64 centers in Europe, Asia, Australia, and New Zealand, the risk of symptomatic intracranial hemorrhage was lower among the 832 patients taking direct oral anticoagulant treatment compared with controls with no anticoagulation. This result was consistent among subgroups and different selection strategies. Meaning This study found insufficient evidence of excess harm associated with the use of off-label intravenous thrombolysis in selected patients who had taken a direct oral anticoagulant within the previous 48 hours.