Yan S, Zhang X, Zhang R, et al. - In patients receiving reperfusion therapy, including intravenous thrombolysis (IVT) with or without endovascular thrombectomy (EVT), researchers explored the connection between early fibrinogen depletion and symptomatic intracranial hemorrhage (sICH). Participants in the study were 1,135 stroke patients with baseline and follow-up fibrinogen levels at 2 hours after the start of alteplase infusion for those with IVT only or immediately after the end of EVT for those with combined IVT and EVT. Based on automated perfusion imaging, patients got alteplase up to 9 hours after the onset or on awakening. Baseline fibrinogen level was 3.36 ± 0.94 g/L and decreased to 2.47 ± 0.80 g/L at 2 hours following the beginning of alteplase infusion in patients with IVT only. Baseline fibrinogen level was 3.35 ± 0.82 g/L and decreased to 2.52 ± 0.83 g/L immediately following the end of EVT in patients with IVT followed by EVT. After reperfusion therapy with alteplase, an early decrease in fibrinogen levels was associated with sICH. It is necessary to test more fibrin-specific thrombolytic agents in patients with acute ischemic stroke.