Thrombolysis and thrombectomy in patients treated with dabigatran with acute ischemic stroke: Expert opinion

H C Diener; R Bernstein; K Butcher; B Campbell; G Cloud; A Davalos; S Davis; J M Ferro; M Grond; D Krieger; G Ntaios; A Slowik; E Touzé

doi:10.1177/1747493016669849

Thrombolysis and thrombectomy in patients treated with dabigatran with acute ischemic stroke: Expert opinion

Int J Stroke. 2017 Jan;12(1):9-12. doi: 10.1177/1747493016669849. Epub 2016 Sep 30.

Authors

H C Diener¹, R Bernstein^{2

3}, K Butcher⁴, B Campbell⁵, G Cloud⁶, A Davalos⁷, S Davis⁸, J M Ferro⁹, M Grond¹⁰, D Krieger^{11

12}, G Ntaios¹³, A Slowik¹⁴, E Touzé¹⁵

Affiliations

¹ 1 Department of Neurology, University Duisburg-Essen, Essen, Germany.
² 2 Northwestern Stroke Program, Chicago, IL, USA.
³ 3 Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
⁴ 4 Division of Neurology, University of Alberta, Edmonton, AB, Canada.
⁵ 5 Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
⁶ 6 The Department of Neurology, Atkinson Morley's Wing, St George's University Hospitals NHS Foundation Trust, London, UK.
⁷ 7 Department of Neurosciences, Hospital Germans Trias I Pujol, Universidad Autònoma de Barcelona, Barcelona, Spain.
⁸ 8 Department of Translational Neuroscience, University of Melbourne, Victoria, Australia.
⁹ 9 Department of Neurosciences and Mental Health, Hospital Santa Maria - CHLN, University of Lisbon, Lisbon, Portugal.
¹⁰ 10 Department of Neurology, Kreisklinikum Siegen, Germany.
¹¹ 11 Comprehensive Stroke Center, University of Zurich, Zurich, Switzerland.
¹² 12 Cityhospital Mediclinic, Dubai Health Care City, Dubai, UAE.
¹³ 13 Department of Medicine, University of Thessaly, Larissa, Greece.
¹⁴ 14 Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland.
¹⁵ 15 Normandie University, UNICAEN, Inserm U919, Department of Neurology, Caen, France.

PMID: 27694315
DOI: 10.1177/1747493016669849

Abstract

Systemic thrombolysis with rt-PA is contraindicated in patients with acute ischemic stroke anticoagulated with dabigatran. This expert opinion provides guidance on the use of the specific reversal agent idarucizumab followed by rt-PA and/or thrombectomy in patients with ischemic stroke pre-treated with dabigatran. The use of idarucizumab followed by rt-PA is covered by the label of both drugs.

Keywords: Ischemic stroke; dabigatran; idarucizumab; rt-PA; thrombectomy; thrombolysis.

MeSH terms

Antithrombins / therapeutic use*
Brain Ischemia / prevention & control
Brain Ischemia / therapy*
Dabigatran / therapeutic use*
Humans
Stroke / prevention & control
Stroke / therapy*
Thrombectomy*
Thrombolytic Therapy*

Substances

Antithrombins
Dabigatran