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Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan.
- Source :
-
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2019 Mar; Vol. 28 (3), pp. 815-820. Date of Electronic Publication: 2018 Dec 17. - Publication Year :
- 2019
-
Abstract
- Background: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan.<br />Methods: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies.<br />Results: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose .78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P = .016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality.<br />Conclusion: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.<br /> (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Antibodies, Monoclonal, Humanized adverse effects
Atrial Fibrillation blood
Atrial Fibrillation diagnosis
Atrial Fibrillation mortality
Cerebral Hemorrhage chemically induced
Dabigatran administration & dosage
Dabigatran adverse effects
Drug Administration Schedule
Feasibility Studies
Female
Fibrinolytic Agents adverse effects
Humans
Infusions, Intravenous
Male
Middle Aged
Retrospective Studies
Risk Factors
Stroke blood
Stroke diagnosis
Stroke mortality
Taiwan epidemiology
Thrombolytic Therapy adverse effects
Thrombolytic Therapy mortality
Time Factors
Tissue Plasminogen Activator adverse effects
Treatment Outcome
Antibodies, Monoclonal, Humanized administration & dosage
Antithrombins administration & dosage
Antithrombins adverse effects
Atrial Fibrillation drug therapy
Blood Coagulation drug effects
Dabigatran antagonists & inhibitors
Fibrinolytic Agents administration & dosage
Stroke drug therapy
Thrombolytic Therapy methods
Tissue Plasminogen Activator administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8511
- Volume :
- 28
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
- Publication Type :
- Academic Journal
- Accession number :
- 30573284
- Full Text :
- https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.029