Thrombolysis in an Ischemic Stroke Patient on Dabigatran Anticoagulation: A Case Report

Marrone, Luiz Carlos Porcello; Marrone, A.

doi:10.1159/000342307

Cited by 25 publications

(13 citation statements)

References 16 publications

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“…Currently, the literature on intravenous alteplase administration in stroke patients taking dabigatran is limited to only case reports 188,[194][195][196][197][198] (Table 15). In these, 1 intracranial hemorrhage was reported, which was fatal.…”

Section: Direct Thrombin Inhibitor (Dabigatran and Argatroban)mentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

550

237

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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Section: Direct Thrombin Inhibitor (Dabigatran and Argatroban)mentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

550

237

View full text Add to dashboard Cite

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“…One could speculate that the favorable clinical outcome and the absence of bleeding complications in this case were related to the reduced dose of rivaroxaban as well as the relatively long interval between the last drug intake and IVT. Longer dosing intervals were also associated with a good functional outcome in stroke patients taking another direct oral anticoagulant (DOAC), dabigatran, before IVT [5,6,7], whereas a fatal ICH occurred in another patient who underwent thrombolysis only 3 h after dabigatran intake [8]. …”

Section: Discussionmentioning

confidence: 99%

Intravenous Thrombolysis in a Stroke Patient Receiving Rivaroxaban

Fluri

Heinen

Kleinschnitz³

2013

Cerebrovasc Dis Extra

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“…One patient with several risk factors for hemorrhagic transformation (diabetes mellitus with hyperglycemia upon presentation and a large perfusion deficit on CT) who received thrombolysis suffered a fatal secondary intracerebral hemorrhage after thrombolysis despite normal coagulation parameters [7]. Five other patients received rt-PA without intracranial hemorrhagic complications (table 1), but one patient also developed skin ecchymoses [8, 9, 10, 11, 12]. These cases indicate that thrombolysis might be safe if the aPTT is in the normal range, indicating that little dabigatran is present.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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We present the case of an aphasic 77-year-old stroke patient with left distal M1 occlusion who received rt-PA for thrombolysis while on oral anticoagulant treatment with dabigatran (150 mg b.i.d.). Coagulation parameters were normal (thrombin time 20 s, aPTT 20 s, INR 1.08) and the patient improved from an NIHSS of 15 to 5 within 24 h with sonographic evidence of M1 recanalization. She did not develop intracranial bleeding complications but showed unusually large diffuse skin ecchymoses. In our report, we give an overview of all reported cases of thrombolysis under dabigatran anticoagulation and discuss the questions of medication adherence under novel oral anticoagulants (NOA) and the safety of NOA in terms of secondary intracerebral hemorrhage after stroke.

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Thrombolysis in an Ischemic Stroke Patient on Dabigatran Anticoagulation: A Case Report

Cited by 25 publications

References 16 publications

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Intravenous Thrombolysis in a Stroke Patient Receiving Rivaroxaban

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

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