Intravenous Fibrinolysis in Ischemic Stroke of Large Vessel after Reversing Effect of Dabigatran with Idarucizumab

J Stroke Cerebrovasc Dis. 2017 Sep;26(9):e192-e193. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.032. Epub 2017 Jun 26.

Abstract

Currently the use of idarucizumab to reverse the effect of dabigatran emerges as a possibility of treatment for those patients who present with an ischemic stroke despite taking this anticoagulant. We present our experience regarding the use of intravenous tissue plasminogen activator in a patient with ischemic stroke due to complete occlusion of the left middle cerebral artery after blocking the effect of dabigatran with idarucizumab and whose result was an almost total improvement of the neurologic deficit. The use of this monoclonal antibody without a prothrombotic effect seems safe to be an intravenous fibrinolytic treatment option for patients taking dabigatran and having an ischemic stroke; however, more extensive studies are needed to determine its safety and efficacy.

Keywords: Ischemic stroke; dabigatran; idarucizumab; intravenous tissue plasminogen activator.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Aged
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Anticoagulants / administration & dosage
  • Blood Coagulation / drug effects*
  • Dabigatran / administration & dosage
  • Dabigatran / antagonists & inhibitors*
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Humans
  • Infarction, Middle Cerebral Artery / diagnostic imaging
  • Infarction, Middle Cerebral Artery / drug therapy*
  • Thrombolytic Therapy*
  • Tissue Plasminogen Activator / administration & dosage*
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal, Humanized
  • Anticoagulants
  • Fibrinolytic Agents
  • idarucizumab
  • Tissue Plasminogen Activator
  • Dabigatran