Safety of early initiation of rivaroxaban or dabigatran after thrombolysis in acute ischemic stroke

T Ritzenthaler; L Derex; C Davenas; W Bnouhanna; A Farghali; L Mechtouff; T-H Cho; N Nighoghossian

doi:10.1016/j.neurol.2015.02.012

Safety of early initiation of rivaroxaban or dabigatran after thrombolysis in acute ischemic stroke

Rev Neurol (Paris). 2015 Sep;171(8-9):613-5. doi: 10.1016/j.neurol.2015.02.012. Epub 2015 Apr 7.

Authors

T Ritzenthaler¹, L Derex², C Davenas², W Bnouhanna², A Farghali², L Mechtouff², T-H Cho³, N Nighoghossian³

Affiliations

¹ Service d'urgences neuro-vasculaires, hôpital neurologique Pierre-Wertheimer, hospices civils de Lyon, 59, boulevard Pinel, 59677 Bron cedex, France; CREATIS, université de Lyon, CNRS UMR 5220, Inserm U1044, INSA-Lyon, université Lyon 1, hospices civils de Lyon, 69500 Villeurbanne cedex, France. Electronic address: [email protected].
² Service d'urgences neuro-vasculaires, hôpital neurologique Pierre-Wertheimer, hospices civils de Lyon, 59, boulevard Pinel, 59677 Bron cedex, France.
³ Service d'urgences neuro-vasculaires, hôpital neurologique Pierre-Wertheimer, hospices civils de Lyon, 59, boulevard Pinel, 59677 Bron cedex, France; CREATIS, université de Lyon, CNRS UMR 5220, Inserm U1044, INSA-Lyon, université Lyon 1, hospices civils de Lyon, 69500 Villeurbanne cedex, France.

PMID: 25857461
DOI: 10.1016/j.neurol.2015.02.012

Abstract

The introduction of direct oral anticoagulants (DOA) in the early stage of cerebral infarction after thrombolysis may reduce the recurrence rate but raises safety concern. We sought to study the feasibility and safety of the introduction of rivaroxaban or dabigatran in this context. Thirty-four consecutive patients admitted for ischemic stroke related to non-valvular atrial fibrillation in whom DOA were given within the first two weeks following intravenous rt-PA were studied. A clinical and radiological monitoring protocol was established to ensure the safety of the prescription. None of the patients experienced symptomatic hemorrhagic transformation or a symptomatic recurrent ischemic event after early rivaroxaban or dabigatran introduction.

Keywords: Accident ischémique cérébral; Acute stroke; Anticoagulant direct; Anticoagulants; Atrial fibrillation; Dabigatran; Dabigatran etexilate; Fibrillation atriale; Rivaroxaban; Thrombolysis.

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Antithrombins / administration & dosage
Antithrombins / adverse effects
Antithrombins / therapeutic use*
Atrial Fibrillation / blood
Atrial Fibrillation / complications
Brain Ischemia / drug therapy*
Dabigatran / administration & dosage
Dabigatran / adverse effects
Dabigatran / therapeutic use*
Drug Administration Schedule
Factor Xa Inhibitors / administration & dosage
Factor Xa Inhibitors / adverse effects
Factor Xa Inhibitors / therapeutic use*
Female
Fibrinolytic Agents / administration & dosage
Fibrinolytic Agents / therapeutic use*
Humans
Intracranial Hemorrhages / chemically induced*
Intracranial Hemorrhages / diagnostic imaging
Length of Stay
Male
Pilot Projects
Radiography
Recombinant Proteins / administration & dosage
Recombinant Proteins / therapeutic use
Recurrence
Retrospective Studies
Rivaroxaban / administration & dosage
Rivaroxaban / adverse effects
Rivaroxaban / therapeutic use*
Severity of Illness Index
Thrombolytic Therapy*
Thrombophilia / drug therapy
Thrombophilia / etiology
Tissue Plasminogen Activator / administration & dosage
Tissue Plasminogen Activator / therapeutic use*

Substances

Antithrombins
Factor Xa Inhibitors
Fibrinolytic Agents
Recombinant Proteins
Rivaroxaban
Tissue Plasminogen Activator
Dabigatran