A 67-year-old man presents 2.5 hours after disabling stroke symptoms. Glucose 140 mg/dL, platelets 180k/μL, INR 1.0, BP 170/100 mmHg. He took apixaban...

Question

A 67-year-old man presents 2.5 hours after disabling stroke symptoms. Glucose 140 mg/dL, platelets 180k/μL, INR 1.0, BP 170/100 mmHg. He took apixaban 8 hours ago. Management?

Accepted Answer

Do not give alteplase due to recent DOAC use

Answer

Give alteplase now

Answer

Give tenecteplase now

Answer

Reverse apixaban then give alteplase routinely

Answer

Proceed with mechanical thrombectomy only without imaging

us-abem MCQ (SBA): Thrombolysis Contraindications

A 67-year-old man presents 2.5 hours after disabling stroke symptoms. Glucose 140 mg/dL, platelets 180k/μL, INR 1.0, BP 170/100 mmHg. He took apixaban 8 hours ago. Management?