Thrombolysis in Direct Oral Anticoagulant–Treated Stroke Patients: Cross-Sectional Survey of Canadian Practice

Intravenous thrombolysis for ischemic stroke after recent direct oral anticoagulant (DOAC) ingestion remains controversial due to hemorrhagic risk, limited rapid testing and inconsistent reversal strategies. We conducted an invite-only, web-based cross-sectional survey of Canadian stroke centers using a structured questionnaire. DOAC level testing was inconsistently available, with 9/13 centers (69%) reporting access but 8/13 centers (61%) reporting turnaround times exceeding 30 minutes. Consequently, 9/13 centers (69%) did not routinely use DOAC levels to guide thrombolysis decisions. Current practice demonstrates substantial variability and uncertainty, highlighting important evidence gaps and the potential role of clinical trials and consensus guideline development.