Why the study?
Does idarucizumab followed by thrombolytic therapy improve outcomes and allow safe treatment in patients with atrial fibrillation who develop ischemic stroke while taking dabigatran?
Does idarucizumab followed by thrombolytic therapy improve outcomes and allow safe treatment in patients with atrial fibrillation who develop ischemic stroke while taking dabigatran?
The administration of idarucizumab allows for safe thrombolytic therapy in patients with atrial fibrillation who develop ischemic stroke while on dabigatran.
Supports feasibility of idarucizumab before thrombolysis in dabigatran-associated stroke; leaves open need for prospective validation before practice change.
The paper describes a clinical case in which an 84-year-old patient with non-valvular atrial fibrillation (AF) who took dabigatran 110 mg twice a day developed recurrent ischemic stroke (IS) that caused dysarthria, left-sided hemiparesis, pain sensitivity and movement coordination impairments. At 170 minutes after IS development, idarucizumab was prescribed and thrombolytic therapy (TLT) was performed to neutralize the anticoagulant effect of dabigatran. At 24 hours after TLT, the National Institutes of Health Stroke Scale (NIHSS) scores were observed to decrease from 11 to 8; and repeated brain computed tomography revealed an ischemic focus in the left cerebellar hemisphere with hemorrhagic transformation to hemorrhagic heart attack type I. On day 19 of IS following the reversal of hemorrhagic transformation, dabigatran was resumed at a dose 110 mg twice a day. The described case, as well as other authors' data that reflect real clinical practice, confirms that the administration of idarucizumab is safe and allows TLT to be performed in patients with AF who develop IS while taking dabigatran.
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Pudov et al. (2020) studied this question.
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