Key result
Case report describes accidental IV thrombolysis with rt-PA in an acute stroke patient on apixaban.
Why the study?
Intravenous thrombolysis is contraindicated in stroke patients receiving oral anticoagulants, and point-of-care devices used to monitor vitamin K antagonists are not always suitable for accurately measuring the anticoagulant activity of new oral anticoagulants.
Case Report (n=1)
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is contraindicated in stroke patients receiving oral anticoagulants [1] . Knowledge of current medication is therefore necessary before commencing IVT. In the emergency setting, pointof-care (POC) coagulation devices provide rapid international normalized ratio (INR) measurements [2] . However, current POC devices that are used to monitor vitamin K antagonists are not always suitable for accurately measuring anticoagulant activity of the new oral anticoagulants (NOACs) [3] . We report an ‘accidental’ thrombolysis in a stroke patient in whom treatment with apixaban, a NOAC that inhibits factor Xa (FXa), became apparent only after the completion of IVT.
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Fluri et al. (2015) conducted a case report in Stroke (n=1). Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) during apixaban therapy was evaluated. Intravenous thrombolysis with rt-PA was accidentally administered to 1 stroke patient whose treatment with apixaban became apparent only after completion of the infusion.
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