Idarucizumab Reversal Before Thrombolysis in AIS Patients Shows Comparable Safety

For many patients with acute ischemic stroke, intravenous thrombolysis is a time-sensitive intervention critical for improving functional outcomes. A significant clinical challenge arises, however, in the large number of patients on direct oral anticoagulants (DOACs) for conditions like atrial fibrillation, a primary risk factor for ischemic stroke [1, 2]. Guidelines have historically contraindicated thrombolysis in these patients due to a perceived high risk of symptomatic intracranial hemorrhage [3, 4]. This creates a therapeutic impasse, potentially denying a beneficial treatment. The development of specific reversal agents, such as idarucizumab for dabigatran, offers a potential pathway to safely administer thrombolysis in this population [5, 6]. While early systematic reviews have been compiled, large-scale, real-world registry data are needed to provide clinicians with robust evidence to guide practice [7].