Grant: Project Grant

The proposed DOSE study is an important study focused on finding better ways to treat people who have acute stroke due to blockage of arteries in the brain (ischemic stroke) while being on strong blood thinners called direct oral anticoagulants (DOACs). Right now, doctors use clot busting medication (called tenecteplase) to dissolve the clot and restore blood flow in patients presenting with stroke-like symptoms within 4.5h from symptom onset. However, if a person has recently taken certain blood thinners called direct oral anticoagulants (DOACs) within last 48 hours of onset, doctors worry that using clot busting medication might cause dangerous bleeding in the brain. Because of this, patients who have taken DOACs are not given clot busting medication as per current guideline recommendations. The current study aims to find out if clot busting medication (tenecteplase) can be safely used in these patients, and whether it helps them recover better. The study will also test to see what dose works best in these patients. Thus, patients who have recently taken a DOAC (within 48 hours) participating in this study will have a random chance to receive either standard dose tenecteplase or low dose tenecteplase or no tenecteplase. The goal is to see if patients who have taken DOACs can still get the treatment they need at the safest dose to improve their chances of recovering from a stroke. If the study shows that tenecteplase is safe and effective, it could change how doctors treat stroke patients who are on blood thinners. The results of the study will be shared widely so that doctors, patients, and their families can understand the best and safest ways to treat strokes in people taking blood thinners.