Documented Gingival Bleeding, Hematuria, and Upper Gastrointestinal Bleeding After Intravenous Alteplase in Older Adults with Acute Ischemic Stroke: A Retrospective Single-Center Cohort Study

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Background and Objectives: Extracranial bleeding after intravenous alteplase is less consistently characterized than symptomatic intracranial hemorrhage. This study describes three site-specific manifestations—gingival bleeding, hematuria, and upper gastrointestinal bleeding—documented after alteplase in older adults with acute ischemic stroke. Materials and Methods: This retrospective single-center cohort included 95 patients aged ≥65 years treated between 2020 and 2024. The analysis was limited to the three site-specific extracranial bleeding variables retained in the analytical dataset; other extracranial sites were not systematically available. Site-specific frequencies were the primary outcomes, while documentation of any of the three manifestations was a secondary summary measure. A positive event required documentation after alteplase during the index hospitalization. Exact event-recognition intervals and standardized severity data were unavailable; therefore, immediate hemorrhagic complications and causality could not be assessed. Frequencies were reported with exact Clopper–Pearson confidence intervals, and three secondary antithrombotic exposure analyses used exact odds ratios. Results: Gingival bleeding was documented in five patients (5.3%; exact 95% confidence interval [CI], 1.7%–11.9%), hematuria in four (4.2%; 1.2%–10.4%), and upper gastrointestinal bleeding in one (1.1%; 0.03%–5.7%). The secondary any-of-three measure occurred in 10 patients (10.5%; 5.2%–18.5%). Odds ratios were 1.30 (95% CI, 0.20–6.37) for oral anticoagulant exposure, 1.29 (0.28–6.08) for antiplatelet exposure, and 1.18 (0.25–5.53) for either class. Twenty-two of the 24 oral anticoagulant users also received antiplatelet therapy. Conclusions: These results represent hospitalization-level documentation of three analyzed sites, not the overall burden of extracranial bleeding or the incidence of immediate alteplase-related complications. The wide confidence intervals can neither confirm nor exclude clinically meaningful associations with pre-stroke antithrombotic exposure.

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