Key result
Treatment with idarucizumab to reverse dabigatran followed by intravenous alteplase resulted in complete resolution of acute ischemic stroke symptoms with no adverse outcomes.
Why the study?
Treatment options for anticoagulated patients presenting with ischemic stroke are limited, and off-label idarucizumab use to reverse dabigatran may ensure eligibility for alteplase.
Does idarucizumab followed by intravenous alteplase safely treat acute ischemic stroke in a patient on dabigatran?
Case Report (n=1)
Does idarucizumab followed by intravenous alteplase safely treat acute ischemic stroke in a patient on dabigatran?
Off-label use of idarucizumab to reverse dabigatran allowed for successful and safe administration of intravenous alteplase in a patient with acute ischemic stroke.
May enable thrombolysis after dabigatran reversal; single case leaves open need for prospective trials.
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.
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Jala et al. (2018) conducted a case report in Acute Ischemic Stroke (n=1). Idarucizumab and intravenous alteplase was evaluated on Adverse outcomes and stroke symptom resolution. Treatment with idarucizumab to reverse dabigatran followed by intravenous alteplase resulted in complete resolution of acute ischemic stroke symptoms with no adverse outcomes.
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