Selected Extracranial Bleeding Documented After Intravenous Alteplase in Older Adults with Acute Ischemic Stroke: Gingival Bleeding, Hematuria, and Upper Gastrointestinal Bleeding

Background and Objectives: Symptomatic intracranial hemorrhage is the principal safety concern after intravenous alteplase, whereas site-specific extracranial bleeding is less consistently documented. This study described the frequency and anatomical distribution of gingival bleeding, hematuria, and upper gastrointestinal bleeding recorded after alteplase in older adults with acute ischemic stroke. Secondary exploratory analyses assessed unadjusted associations with pre-stroke antithrombotic exposure. Materials and Methods: This retrospective single-center cohort included 95 patients aged ≥65 years who received intravenous alteplase between 2020 and 2024. The selected-bleeding outcome indicated documentation of at least one of the three manifestations during hospitalization. Frequencies were reported with exact Clopper–Pearson confidence intervals; exploratory comparisons used Fisher’s exact tests, Mann–Whitney U tests, and exact odds ratios. Results: Median age was 77 years (interquartile range, 72–82). Selected extracranial bleeding was documented in 10 patients (10.5%; exact 95% confidence interval, 5.2%–18.5%): gingival bleeding in five, hematuria in four, and upper gastrointestinal bleeding in one. Odds ratios were 1.30 (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. Exploratory comparisons did not identify a distinct clinical or in-hospital profile. Conclusions: Selected extracranial bleeding was documented in 10.5% of patients, with gingival bleeding as the most frequent of the three selected manifestations. Pre-stroke antithrombotic exposure was not significantly associated with the selected-bleeding outcome, although estimates were imprecise. Standardized site-specific documentation and larger prospective studies are needed.