Thrombolysis in a Stroke Patient on Dabigatran Anticoagulation: Case Report and Synopsis of Published Cases

Pfeilschifter, Waltraud; Abruscato, Mario; Hövelmann, Susanne; Baas, H.

doi:10.1159/000350570

Cited by 16 publications

(7 citation statements)

References 32 publications

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“…8,9 The knowledge about IVT in NOAC patients is limited and based on case reports. [14][15][16][17][18]20,21,24 Data from animal models showed no excessive risk of ICH after IVT in rodents with a prior treatment with rivaroxaban, 43,44 dabigatran, 45,46 and apixaban 44 in comparison with VKA. Currently, the use of IVT for acute ischemic stroke in patients with a recent (<48 hours) intake of a NOAC is regarded off-label.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] Furthermore, a few case reports on the use of IVT in patients taking dabigatran, [14][15][16][17][18] rivaroxaban, [19][20][21][22] or apixaban, 23 or IAT while taking dabigatran 24 reported favorable clinical outcomes. Conversely, 1 patient with ischemic stroke under dabigatran treatment had a fatal intracranial hemorrhage (ICH) associated with IVT.…”

Section: Clinical Perspective On P 1269mentioning

confidence: 99%

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Recanalization Therapies in Acute Ischemic Stroke Patients

et al. 2015

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Background-We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients withischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results-This is a multicenter cohort pilot study. Primary outcome measures were (1) in no-OAC patients. sICH ECASS-II and sICH NINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences. Conclusions-IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective On P 1269mentioning

confidence: 99%

Recanalization Therapies in Acute Ischemic Stroke Patients

et al. 2015

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“…Kate argues that even subtherapeutic plasma concentrations of dabigatran and other antithrombotic agents exert a protective effect by reducing clot burden and/or increasing the likelihood of spontaneous recanalization . Pfeilschifter et al reported that all cases of stroke under dabigatran which received t‐PA so far did not show relevant alterations of the aPTT . While noncompliance may be an issue for DOACs, our patient plausibly denied irregular intake.…”

Section: Discussionmentioning

confidence: 67%

Intravenous thrombolysis in acute ischemic stroke after dabigatran reversal with idarucizumab – a case report

Mutzenbach

Pikija

Otto

et al. 2016

Ann Clin Transl Neurol

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Much excitement has been generated with the approval of idarucizumab, a humanized monoclonal antigen‐binding antibody fragment that is capable of reversing the anticoagulant activity of dabigatran. Here, we describe our initial experience of using tissue plasminogen activator (tPA) in an acute posterior circulation ischemic stroke after dabigatran reversal with idarucizumab. Both treatments were well tolerated and no hemorrhagic or procoagulatory complications were observed. We propose that the option of dabigatran reversal needs to be considered for contemporary treatment concepts of acute ischemic stroke.

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“…In contrast to patients taking VKAs with an INR of ≤1.7 that can be considered for treatment with intravenous recombinant tissue plasminogen activator (rtPA), ischemic stroke patients taking NOACs are typically excluded from treatment with intravenous rtPA. Although isolated case reports exist describing variable outcomes in acute ischemic stroke patients treated with thrombolysis while taking dabigatran [12], there is lack of consensus on how vascular neurologists would treat otherwise rtPA-eligible patients [13]. Large, well-designed studies will be necessary to determine if rapidly measured anticoagulant effect of NOACs can predict symptomatic intracranial hemorrhage or functional outcomes following thrombolysis.…”

Section: Stroke Prevention In Atrial Fibrillationmentioning

confidence: 99%

Stroke: Advances in Medical Therapy and Acute Stroke Intervention

2015

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Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythmia. Some accepted ischemic stroke preventative strategies, such as carotid revascularization for asymptomatic carotid stenosis, require reassessment, given advances in risk factor management, antithrombotic therapy, and surgical techniques. Intra-arterial therapy, particularly with stent retrievers after intravenous tissue plasminogen activator, has recently been demonstrated to improve functional outcomes and will require investment in system-based care models to ensure that effective treatments are received by patients in a timely fashion. The purpose of this review is to describe recent advances in medical and surgical approaches to ischemic stroke prevention and acute treatment. Results from recently published clinical trials will be highlighted along with ongoing clinical trials addressing key questions in ischemic stroke management and prevention where equipoise remains.

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Thrombolysis in a Stroke Patient on Dabigatran Anticoagulation: Case Report and Synopsis of Published Cases

Cited by 16 publications

References 32 publications

Recanalization Therapies in Acute Ischemic Stroke Patients

Recanalization Therapies in Acute Ischemic Stroke Patients

Intravenous thrombolysis in acute ischemic stroke after dabigatran reversal with idarucizumab – a case report

Stroke: Advances in Medical Therapy and Acute Stroke Intervention

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