Historically, systemic and catheter-directed thrombolysis, often using tissue plasminogen activator (tPA), carries significant risk of major bleed. It remains unknown whether endovascular pharmacomechanical thrombolysis also shares this risk of major bleed. It also remains unknown whether novel endovascular modalities without tPA can improve on this bleeding risk while still achieving technical and long-term success. We hypothesized that mechanical thrombectomy without tPA would decrease bleeding complications compared with endovascular pharmacomechanical interventions with the use of tPA in a wide range of endovascular procedures, including treatment of acute stroke, pulmonary embolism, deep venous thrombosis, and peripheral arterial occlusion. A retrospective chart review of consecutive patients using selected Current Procedural Terminology codes with endovascular pharmacomechanical thrombolysis with tPA (tPA cohort) and thrombectomy procedures without tPA (non-tPA cohort) at a single tertiary care university institution between 2008 and 2017 was performed. The primary dependent variable was the presence or absence of postoperative bleeding, including but not limited to hematochezia, subarachnoid hemorrhage and hemorrhagic conversion, hematemesis, hemoptysis, pseudoaneurysm, and bleeding from a catheter insertion site. The secondary outcome measured was the longevity of primary patency (in days) of the vessel on which procedures were performed. Propensity score matching of independent variables was used to match patients in the tPA cohort vs the non-tPA cohort for two-sample analysis. Two-tailed t-tests were then used to compare patency and presence or absence of bleeding between the groups. We identified 370 consecutive patients (tPA, n = 324; non-tPA, n = 46; Table I). After propensity score matching (Table II), there was no significant difference in any of the independent variables used to describe the patients between cohorts. Comparison of duration of patency between the groups revealed no significant difference (tPA, 1380 days; non-tPA, 1190 days; P = .42), nor did the incidence of postoperative bleeding vary with or without the use of tPA in this study (P = .50). We demonstrate that bleeding risk and patency are not significantly different in the presence or absence of tPA use with novel pharmacomechanical endovascular interventions.Table IDemographics of full data set of tissue plasminogen activator (tPA) and non-tPA cohortsDemographicstPA cohort, %Non-tPA cohort, %Female41.752.2End-stage renal disease10.54.3Stroke history33.045.7Congestive heart failure28.426.1Myocardial infarction23.123.9Coronary artery disease44.443.5Peripheral vascular disease44.432.6Hypertension78.163.0Diabetes mellitus40.732.6Chronic obstructive pulmonary disease17.919.6Hyperlipidemia63.356.530-Day mortality9.913.0Age, years67.167.7 Open table in a new tab Table IIDemographics of tissue plasminogen activator (tPA) and non-tPA cohorts after propensity score matchingDemographicstPA cohort, No. (%)Non-tPA cohort, No. (%)Female10 (21.0)24 (52.2)End-stage renal disease4 (8.7)2 (4.3)Stroke history17 (37.0)20 (43.5)Congestive heart failure13 (28.3)12 (26.1)Myocardial infarction12 (26.1)11 (23.9)Coronary artery disease19 (41.3)20 (40.5)Peripheral vascular disease15 (32.6)15 (32.6)Hypertension35 (76.1)29 (63.0)Diabetes mellitus22 (47.8)15 (32.6)Chronic obstructive pulmonary disease9 (19.5)9 (19.6)Hyperlipidemia28 (60.9)26 (56.5)30-Day mortality7 (15.2)6 (13.0)Age, years64.068.0 Open table in a new tab