Treatment With Intravenous Alteplase for Acute Ischemic Stroke After Reversal of Dabigatran With Idarucizumab: A Case Study

Abstract

Treatment options for anticoagulated patients presenting with ischemic stroke are limited. Off-label use of idarucizumab to rapidly reverse the anticoagulant effect of dabigatran may ensure eligibility for thrombolytic therapy with alteplase. This case describes a 77-year-old white male who presented to the hospital 89 minutes after sudden onset of right-sided hemiparesis, dysarthria, and facial palsy. Significant history included atrial fibrillation and previous right-sided cortical stroke. Medication reconciliation revealed he was taking dabigatran 150 mg twice a day, with the last dose being 179 minutes before presentation. Neuroimaging revealed no new infarct or hemorrhage, and 60 minutes after arrival, a decision was made to give idarucizumab to reverse the anticoagulant effect of dabigatran. In the absence of any contraindication, he was then treated with intravenous alteplase and idarucizumab. No adverse outcomes were noted, and at discharge, his new stroke symptoms were completely resolved.

Intravenous Thrombolysis After Dabigatran Reversal by Idarucizumab: A Systematic Review of the Literature

“…Among 463 articles identified from the initial literature search, 49 studies including 251 patients were eligible and included in the analysis ( 1 , 13 – 57 , 60 – 63 ) ( Figure 1 ). Forty-five studies provided individual patient data of 119 AIS patients ( 13 – 23 , 25 , 27 – 36 , 38 – 57 , 60 – 63 ), whereas four case-series reported results on overall 151 patients ( 1 , 24 , 26 , 37 ).…”

Providing Stroke and Hypertension Education in Amharic for Ethiopian Persons Living in Dallas, Texas, United States

“…The medication Alteplase is Recombinant Tissue Plasminogen Activator, used to dissolves clots (Jala & O'Brien, 2019). African Americans who were on Medicaid or who had no health-care insurance were found to have lower rates of receiving Alteplase to treat their strokes, and longer delays in presentation to the hospital, than Whites (Johnston et al, 2001).…”