Purpose: Tenecteplase (TNK) is guideline-recommended for acute ischemic stroke (AIS) but carries a risk of symptomatic intracranial hemorrhage (sICH). The purpose of this study is to analyze risk factors for sICH after TNK administration in AIS. Methods: This is a retrospective, IRB approved, observational analysis of hospitalized adults who received intravenous TNK for AIS. Key exclusion criteria include lack of repeat imaging, known factor deficiency, or clotting disorder.The primary objective is the incidence of sICH after TNKadministration. Secondary objectivesencompass: identifying factors associated with hemorrhagic conversion (time from last known normal to TNK administration, time from stroke activation to TNK administration, age > 80 years, NIHSS > 25 or <5, large vessel occlusion, underwent mechanical thrombectomy, smoker, atrial fibrillation, diabetes antiplatelet use and anticoagulant use within past 7 days) and incidence of completing CTH 24 hours after IV thrombolytic was given per protocol. Results: In the 153 patients included, 11 (7.2%) patients developed a sICH after receiving TNK. Age greater than 80 years (p=0.003), antiplatelet use (p=0.019), and NIHSS > 25 (p=0.042) were considered to be potential contributing factors recognized as an increased risk after receiving TNK. Interestingly, patients who received an anticoagulant within the 7 days preceding TNK therapy were associated with a lower risk of developing a sICH, although it was not statistically significant (p=1.000). Thirtypatients (19.6%) did not receive a repeat CTH 24-hours after receiving TNK,which is required per hospital protocolfor thrombolytic use in
