We describe a 75-year-old female patient with nonvalvular atrial fibrillation who presented with acute ischemic stroke during treatment with dabigatran 2 × 110 mg per day. After informed consent, we reversed the anticoagulant effects of dabigatran using idarucizumab and applied an intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (off-label use). An intracerebral hemorrhage was excluded after systemic thrombolysis. Despite the IVT, the patient's clinical condition deteriorated and she developed an ischemic lesion in the right pons, the right thalamus and right cerebellum. To date, the literature lacks data concerning the thrombolytic treatment of acute ischemic stroke in patients after specific reversal of the non-vitamin K oral anticoagulant dabigatran using idarucizumab. Given the rapid and sustainable efficacy of idarucizumab, the reversal of dabigatran followed by thrombolysis seems to be safe, but further studies and register data are still needed to confirm our preliminary observation, especially to provide additional data concerning the risk-benefit evaluation.
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| http://dx.doi.org/10.1159/000447531 | DOI Listing |
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Article Synopsis
- A study evaluated the safety and efficacy of IV thrombolysis (IVT) for acute ischemic stroke (AIS) in patients who received dabigatran reversal with idarucizumab, as limited data exist on this topic.
- Thirteen cohorts and one case series involving 553 patients were analyzed, revealing low rates of symptomatic intracranial hemorrhage (4%), any intracranial hemorrhage (10%), and 3-month mortality (18%).
- Functional outcomes were promising, with 56% achieving excellent outcomes and 70% good outcomes at 3 months, with no significant differences observed between patients treated with idarucizumab and those without.
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