What question did this study set out to answer?

To evaluate the safety and clinical feasibility of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in acute cardioembolic stroke patients receiving dabigatran.

January 1, 2014Rinsho ShinkeigakuOpen Access

Successful thrombolysis without hemorrhage in a patient with cardioembolic stroke under dabigatran treatment―a case report and review of literature

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Why the study?

Is intravenous rt-PA safe and effective for acute ischemic stroke in patients taking dabigatran?

Key Points

To evaluate the safety and clinical feasibility of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in acute cardioembolic stroke patients receiving dabigatran.
Documented the clinical presentation, coagulation status, and treatment timeline of a 72-year-old male with atrial fibrillation who received rt-PA after developing acute ischemic stroke while taking dabigatran (220 mg daily).
Conducted a literature review analyzing clinical outcomes and intracranial hemorrhage incidence across 9 reported cases of thrombolysis administered to dabigatran-treated patients.
Intravenous rt-PA administered 160 minutes post-stroke onset and 7 hours post-dabigatran (APTT 39.1 seconds) resulted in complete recovery (NIHSS 0, 3-month modified Rankin scale 0) without hemorrhage.
Review of 9 reported cases showed favorable outcomes in 8 patients, with intracranial hemorrhage occurring in only 1 severe case.

Structured PICO

Is intravenous rt-PA safe and effective for acute ischemic stroke in patients taking dabigatran?

Population

A 72-year-old male with heart failure and atrial fibrillation who developed acute ischemic stroke (left-sided hemiparesis and dysarthria) while on dabigatran treatment, along with a literature review of 8 additional similar cases (total n=9).

Intervention

Intravenous infusion of rt-PA (alteplase) administered 160 minutes after stroke onset and 7 hours after the last dose of dabigatran.

Outcome

Safety (absence of intracranial hemorrhage) and clinical recovery (NIHSS score and modified Rankin scale at 3 months).safety

Thrombolytic therapy with rt-PA may be safe in patients on dabigatran if administered more than 7 hours after the last dose and when APTT is less than 40 seconds.

Limitations

Small number of accumulated cases (n=9)

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Supports cautious rt-PA use >7 h post-dabigatran with APTT <40 s; hypothesis-generating and leaves open prospective validation.

Cite This Study

Inaishi et al. (2014) studied this question.

synapsesocial.com/papers/6a8212307b739f4dc89cd18b https://doi.org/10.5692/clinicalneurol.54.238

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

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Successful thrombolysis without hemorrhage in a patient with cardioembolic stroke under dabigatran treatment―a case report and review of literature

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Successful thrombolysis without hemorrhage in a patient with cardioembolic stroke under dabigatran treatment―a case report and review of literature

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

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