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Mohamed F Doheim: Clarifying the Role of Late IV Thrombolysis in the Era of Endovascular Therapy

Mohamed F Doheim/X

Jul 27, 2026, 04:11

Mohamed F Doheim: Clarifying the Role of Late IV Thrombolysis in the Era of Endovascular Therapy

Mohamed F Doheim, Assistant Professor in Neurology (Clinical Research), NIH StrokeNet Fellow at the University of Pittsburgh School of Medicine, shared on LinkedIn about a recent article he and his colleagues co-authored, published in Neurology, adding:

”Excited to share my second publication in Neurology in a single day; this time on extended-window IV thrombolysis (IVT) for acute ischemic stroke (4.5–24 hours).

Across 18 RCTs and 5,168 patients, extended-window IVT improved excellent and good functional outcomes and reduced disability on the full mRS spectrum, with the expected increase in sICH but no excess mortality.

The central insight is why trial results have looked so heterogeneous.

Using multivariable meta-regression, we found that the main driver of between-study heterogeneity is whether patients also have access to endovascular thrombectomy (EVT).

Once EVT context is accounted for, much of the apparent variability in IVT effect becomes explainable.

Clinically, this means extended-window IVT may offer its greatest benefit in settings where thrombectomy is unavailable or delayed, especially for more severe strokes, positioning late IVT as a critical global reperfusion strategy rather than a niche protocol.

Proud to help clarify how IVT and EVT interact across trials and health systems, and to contribute evidence that can inform both guideline discussions and stroke systems of care worldwide.”

Title: Exploring Between-Study Heterogeneity in Extended-Window IV Thrombolysis for Acute Ischemic Stroke: A Meta-Analysis of 18 Randomized Controlled Trials

Authors: Mohamed F. Doheim, Abdullah M. Al-Qudah, Romil Singh, Nirav R. Bhatt, Marcelo Rocha, Lawrence R. Wechsler, Gaoting Ma, Gisele Sampaio Silva, Sheila Co Martins, Chunrong Tao, Junwei Hao, Yamei Tang, Wei Hu, Lee H. Schwamm, Thanh N. Nguyen, Raul G. Nogueira

Mohamed F Doheim: Clarifying the Role of Late IV Thrombolysis in the Era of Endovascular Therapy