Why the study?
The approval of idarucizumab allows intravenous thrombolysis despite preexisting dabigatran anticoagulation, raising questions regarding the optimal management and workflow for suspected acute cerebrovascular events.
Does immediate administration of idarucizumab prior to lab and imaging results safely enable intravenous thrombolysis in acute ischemic stroke patients on dabigatran?
Does immediate administration of idarucizumab prior to lab and imaging results safely enable intravenous thrombolysis in acute ischemic stroke patients on dabigatran?
Immediate reversal of dabigatran with idarucizumab prior to lab and imaging results may safely minimize door-to-needle time for IV thrombolysis in acute ischemic stroke.
May support idarucizumab-enabled thrombolysis in dabigatran-treated stroke; leaves open optimal management and safety in larger studies.
We report a case of intravenous thrombolysis in acute ischemic stroke of anterior choroidal artery following the antagonization of dabigatran with idarucizumab. No secondary complication, like hemorrhagic or thrombotic/thrombembolic event, of neither idarucizumab nor subsequent intravenous thrombolysis emerged. The recent approval of idarucizumab enables intravenous thrombolysis despite preexisiting oral anticoagulation with dabigatran, but raises the question of the optimal management and work flow of patients under medication with dabigatran and with acute neurological deficit, highly suspicious for an acute cerebrovascular event. In contrast to hitherto case reports and series, here, we explicitly refrained from awaiting the results of the thrombin time, as a marker for present anticoagulation by dabigatran, as well as the results of cerebral imaging before administration of idarucizumab. Based on the presented case we propose this approach to minimize door-to-needle time of intravenous thrombolysis in acute ischemic stroke and thus to enhance the chance for a good outcome.
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Hieber et al. (2019) studied this question.
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