1
|
Carrillo Navarrete KA, Chapa González C. Hemiplegia in acute ischemic stroke: A comprehensive review of case studies and the role of intravenous thrombolysis and mechanical thrombectomy. IBRAIN 2024; 10:59-68. [PMID: 38682021 PMCID: PMC11045183 DOI: 10.1002/ibra.12146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 05/01/2024]
Abstract
Acute ischemic stroke is a significant health concern worldwide, often leading to long-term disability and decreased quality of life. Rapid and appropriate treatment is crucial for achieving optimal outcomes in these patients. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are two commonly used interventions for acute ischemic stroke, but their effectiveness in improving neurological symptoms and functional outcomes in patients with hemiplegia remains uncertain. The aim of this work was to evaluate the impact of IVT and MT within a 4.5-h time frame on patients with acute ischemic stroke and hemiplegia. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies that assessed the impact of IVT and MT within 4.5-h on hemiplegia in patients with an acute ischemic stroke were included. Data were extracted and analyzed to determine the overall effects of these interventions. Most included case reports indicate positive outcomes in terms of neurological symptom improvement and functional recovery in patients with hemiplegia after receiving IVT and MT within the specified time frame. However, the heterogeneity among the patients and the limited use of IVT due to contraindications posed challenges in determining the most effective treatment option. The findings from the included studies demonstrate that both interventions led to a decrease in National Institutes of Health Stroke Scale scores, indicating an improvement in neurological symptoms. The results highlight the beneficial effects of early thrombolytic interventions and MT on the neurological status and functional outcomes of patients with an acute ischemic stroke.
Collapse
Affiliation(s)
- Karen Adriana Carrillo Navarrete
- Instituto de Ingeniería y TecnologíaUniversidad Autónoma de Ciudad JuárezCiudad Juárez, ChihuahuaMéxico
- Grupo de Nanomedicina, Laboratorio de Integración de Datos y Evidencia en Revisiones de Salud y Ciencia, LIDERSCUniversidad Autónoma de Ciudad JuárezCiudad Juárez, ChihuahuaMéxico
| | - Christian Chapa González
- Instituto de Ingeniería y TecnologíaUniversidad Autónoma de Ciudad JuárezCiudad Juárez, ChihuahuaMéxico
- Grupo de Nanomedicina, Laboratorio de Integración de Datos y Evidencia en Revisiones de Salud y Ciencia, LIDERSCUniversidad Autónoma de Ciudad JuárezCiudad Juárez, ChihuahuaMéxico
| |
Collapse
|
2
|
Stone L, Merriman E, Royle G, Hanna M, Chan H. Retrospective analysis of the effectiveness of a reduced dose of idarucizumab in dabigatran reversal. Thromb Haemost 2021; 122:1096-1103. [PMID: 34814227 DOI: 10.1055/a-1704-0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The recommended dose of idarucizumab, the specific reversal agent for dabigatran etexilate, is 5g. However, published data showed biochemical reversal after an initial 2.5g dose. OBJECTIVES This study aims to retrospectively compare the clinical effectiveness of 2.5g and 5g doses of idarucizumab used in dabigatran reversal in three hospitals in Auckland, New Zealand. METHODS All patients receiving idarucizumab for dabigatran reversal between 1st April 2016 and 31st December 2018 were included. The primary outcome was the likelihood of receiving a second dose of idarucizumab during the same admission. Secondary outcomes included normalisation of coagulation profiles; and 30-day thrombotic, bleeding and mortality rates. RESULTS Of 329 patients included, 206 received an upfront 2.5g dose and 123 received a 5g dose. The median age was 78 years and median creatinine clearance was 50mL/min. Most patients (62.6%) required idarucizumab for an urgent procedure, while 37.4% presented with bleeding. A 2.5g dose was not associated with an increased rate of receiving a second dose (OR 0.686, 95% CI 0.225-2.090). A similar proportion of patients in each group achieved a normal APTT (73.8% vs 80.0%, p=0.464) and dTCT (95.9% vs 91.4%, p=0.379) following idarucizumab infusion. There was no increase in the rate of death (OR 0.602, 95% CI 0.292-1.239), thrombosis (OR 0.386, 95% CI 0.107-1.396) or bleeding (OR 0.96, 95% CI 0.27-3.33) in the 2.5g dose group compared to the 5g dose group. CONCLUSIONS An initial 2.5g dose of idarucizumab appears effective for dabigatran reversal in the real-world setting.
Collapse
Affiliation(s)
- Louisa Stone
- Waitemata District Health Board, Auckland, New Zealand
| | | | | | - Merit Hanna
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand
| | - Henry Chan
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand
| |
Collapse
|
3
|
Gogia B, Young AL, O'Brien BJ, Okhuysen PC, Kumar VA. Bihemispheric Cortical Infarcts in an Adult Secondary to Escherichia coli K1 Meningitis. Case Rep Neurol 2021; 13:572-577. [PMID: 34720964 PMCID: PMC8460961 DOI: 10.1159/000518312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
Cerebral ischemia is a known complication of meningitis. Most Escherichia coli meningitis-induced infarcts have been reported in the neonatal and pediatric population. To the best of our knowledge, there have been no previous reports describing bilateral cortical infarcts in an adult secondary to a K1 strain of E. coli meningitis, and herein we report a case in a 25-year-old female. The challenge in treating this patient was determining the duration of systemic antibiotic treatment and whether or not to use steroids. This study demonstrates the necessity of early diagnosis and treatment of E. coli meningitis to prevent neurological complications, including stroke.
Collapse
Affiliation(s)
- Bhanu Gogia
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Angela L Young
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Barbara J O'Brien
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pablo C Okhuysen
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
4
|
Frol S, Sagris D, Pretnar Oblak J, Šabovič M, Ntaios G. Intravenous Thrombolysis After Dabigatran Reversal by Idarucizumab: A Systematic Review of the Literature. Front Neurol 2021; 12:666086. [PMID: 34149597 PMCID: PMC8209294 DOI: 10.3389/fneur.2021.666086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/03/2021] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose: Idarucizumab achieves instant reversal of anticoagulation and enables intravenous thrombolysis (IVT) in dabigatran-treated acute ischemic stroke (AIS) patients. AIS in dabigatran-treated patients is a rare event, therefore the experience is limited. A review of all published cases was performed to evaluate the safety and effectiveness of this therapeutic strategy. Methods: We searched PubMed and Scopus for all published cases of IVT after reversal with idarucizumab in dabigatran-treated AIS patients. The outcomes were safety assessed by hemorhagic transformation (HT), symptomatic intracranial hemorrhage (SICH) and death, and efficacy assessed by National Institutes of Health Stroke Scale (NIHSS) reduction. Results: We identified 251 AIS patients (39,9% females) with an average age of 74 years. HT, SICH, and death were reported in 19 (7.6%), 9 (3.6%), and 21 (8.4%) patients, respectively. Patients experiencing HT presented with more severe strokes (median NIHSS on admission: 21 vs. 8, p < 0.001; OR: 1.12, 95% CI: 1.05-1.20). After IVT there was a significant NIHSS reduction of 6 points (IQR:3-10, p < 0.001) post-stroke and linear regression revealed a correlation of admission NIHSS to NIHSS reduction (p < 0.001). Conclusions: In this systematic review of all published cases of IVT in dabigatran-treated AIS patients after reversal with idarucizumab the rates of HT, SICH and mortality, as well as NIHSS reduction, were comparable with previous studies in non-anticoagulated patients. This provides reassuring evidence about the safety and efficacy of this therapeutic strategy.
Collapse
Affiliation(s)
- Senta Frol
- Department of Vascular Neurology, University Clinical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Dimitrios Sagris
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Janja Pretnar Oblak
- Department of Vascular Neurology, University Clinical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mišo Šabovič
- Department of Vascular Disorders, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| |
Collapse
|
5
|
Fagundes V, Mesquita M. Two Dabigatran Fast Reversals in a 4-month Period - a Case Report. Eur J Case Rep Intern Med 2020; 6:001311. [PMID: 31893202 PMCID: PMC6936929 DOI: 10.12890/2019_001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction Idarucizumab is available for immediate reversal of dabigatran-induced anticoagulation in life-threatening bleeding or urgent surgery in patients with non-valvular atrial fibrillation (nvAF). Case description We report a case of an 85-year-old female treated with dabigatran for nvAF, submitted to two fast reversal procedures with idarucizumab in a 4-month period. In the first emergency episode, the patient was admitted due to a fall-related cerebral haemorrhage and subdural haematoma. There was a fast reversal of the effects of dabigatran after idarucizumab administration, which allowed stoppage of the bleeding and a decrease in intracranial pressure, with full patient recovery. Four months later, the patient revisited the hospital complaining of diffuse abdominal pain while on the same antithrombotic therapy. Physical examination showed signs of peritoneal irritation and the use of idarucizumab to reverse the effects of dabigatran was decided upon to secure normal bleeding conditions before surgery. Discussion Idarucizumab is an efficient, safe and feasible option for dabigatran-treated nvAF patients, when urgent anticoagulant effect reversal is needed. LEARNING POINTS
Collapse
Affiliation(s)
- Vítor Fagundes
- Internal Medicine, Centro Hospitalar do Tâmega e Sousa (CHTS), EPE, Penafiel, Portugal
| | - Mari Mesquita
- Internal Medicine, Centro Hospitalar do Tâmega e Sousa (CHTS), EPE, Penafiel, Portugal
| |
Collapse
|
6
|
Ohtani T, Sintoku R, Yajima T, Kaneko N. Successful thrombolytic therapy with recombinant tissue plasminogen activator in ischemic stroke after idarucizumab administration for reversal of dabigatran: a case report. J Med Case Rep 2019; 13:390. [PMID: 31875786 PMCID: PMC6931249 DOI: 10.1186/s13256-019-2326-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/26/2019] [Indexed: 12/27/2022] Open
Abstract
Background Idarucizumab is a specific antidote for the anticoagulant dabigatran. Although its efficacy has been recently reported, the drug is still in postmarketing surveillance and requires case data in different emergency settings. A newer intravenous thrombolytic therapy with recombinant tissue plasminogen activator has been proposed after injection of idarucizumab in patients receiving dabigatran; however, the safety and efficacy of this therapy are equivocal because of the limited number of reported cases. We describe a case of a patient with acute lacunar stroke causing dysarthria and hemiparesis successfully treated with intravenous thrombolytic therapy with recombinant tissue plasminogen activator after reversal of dabigatran with idarucizumab. Case presentation A 67-year-old Asian woman was transferred to our emergency center 200 minutes after sudden onset of dysarthria and right-sided hemiparesis. She had been taking dabigatran for prevention of stroke recurrence caused by atrial fibrillation. Diffusion-weighted magnetic resonance imaging revealed a new lacunar infarction near old putamen infarctions. We treated her with intravenous thrombolytic therapy with recombinant tissue plasminogen activator after administering idarucizumab. The time to recombinant tissue plasminogen activator administration was 5 minutes from idarucizumab injection and 269 minutes from symptom onset. The patient’s activated partial thromboplastin times were 68.0 and 43.2 seconds before and after the therapy, respectively. The patient’s neurological symptoms improved significantly after the treatment, and she experienced no adverse events. Conclusions Intravenous thrombolytic therapy with recombinant tissue plasminogen activator after reversal of dabigatran with idarucizumab may be safe and feasible in patients with acute ischemic stroke with lacunar infarct. Furthermore, intravenous thrombolytic therapy with recombinant tissue plasminogen activator could be used in patients in emergency settings until just before the end of the recommended time limit within which it needs to be administered because of the immediate effect of idarucizumab.
Collapse
Affiliation(s)
- Toshiyuki Ohtani
- Department of Neurosurgery, Fukaya Red-Cross Hospital, 5-8-1, Kamishiba-Nishi, Fukaya, Saitama, Japan.
| | - Ryosuke Sintoku
- Department of Neurosurgery, Fukaya Red-Cross Hospital, 5-8-1, Kamishiba-Nishi, Fukaya, Saitama, Japan
| | - Tasuku Yajima
- Department of Neurosurgery, Fukaya Red-Cross Hospital, 5-8-1, Kamishiba-Nishi, Fukaya, Saitama, Japan
| | - Naoyuki Kaneko
- Department of Trauma and Emergency, Fukaya Red-Cross Hospital, Saitama, Japan
| |
Collapse
|
7
|
Toyoda K, Koga M, Iguchi Y, Itabashi R, Inoue M, Okada Y, Ogasawara K, Tsujino A, Hasegawa Y, Hatano T, Yamagami H, Iwama T, Shiokawa Y, Terayama Y, Minematsu K. Guidelines for Intravenous Thrombolysis (Recombinant Tissue-type Plasminogen Activator), the Third Edition, March 2019: A Guideline from the Japan Stroke Society. Neurol Med Chir (Tokyo) 2019; 59:449-491. [PMID: 31801934 PMCID: PMC6923159 DOI: 10.2176/nmc.st.2019-0177] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine
| | | | - Manabu Inoue
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center
| | | | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine
| | | | | | | |
Collapse
|
8
|
Ranasinghe T, Mays T, Quedado J, Adcock A. Thrombolysis Following Heparin Reversal With Protamine Sulfate in Acute Ischemic Stroke: Case Series and Literature Review. J Stroke Cerebrovasc Dis 2019; 28:104283. [PMID: 31324409 PMCID: PMC6800047 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Administering intravenous IV tissue plasminogen activator (tPA) is the recommended standard of care in acute ischemic stroke (AIS), although it is not recommended to administer intravenous thrombolysis with tPA following heparin reversal with protamine sulfate in patients with AIS. METHODS We describe a case series of three patients and the most comprehensive literature review published to date in this specific subset of AIS patients undergoing thrombolysis following heparin reversal with protamine sulfate. The literature review was based on a scoping review methodology performed on four databases; PubMed, CINAHL, Web of Science, and Cochrane Library. All sources were searched from the inauguration of the database until February 2019. A total of six articles involving eight patients were identified. RESULTS The primary safety outcome of no symptomatic intracranial hemorrhage (sICH) was met in all eleven patients, although only seven cases had a good functional outcome at 3 months. CONCLUSIONS In appropriately selected AIS patients, coagulopathy correction appears to be safe from an sICH standpoint and may be beneficial. However, given the potential for bias with observational databases, case reports and case series, extreme caution is warranted in applying these results to routine clinical practice.
Collapse
Affiliation(s)
- Tamra Ranasinghe
- Department of Neurology, West Virginia University, Morgantown, West Virginia.
| | - Traci Mays
- Health Science Library, West Virginia University, Morgantown, West Virginia
| | - Jeff Quedado
- Department of Pharmacy, West Virginia University, Morgantown, West Virginia
| | - Amelia Adcock
- Department of Neurology, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
9
|
Giannandrea D, Caponi C, Mengoni A, Romoli M, Marando C, Gallina A, Marsili E, Sacchini E, Mastrocola S, Padiglioni C, Mazzoli T, Cenciarelli S, Ricci S. Intravenous thrombolysis in stroke after dabigatran reversal with idarucizumab: case series and systematic review. J Neurol Neurosurg Psychiatry 2019; 90:619-623. [PMID: 30032118 DOI: 10.1136/jnnp-2018-318658] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/11/2018] [Accepted: 06/26/2018] [Indexed: 12/18/2022]
Affiliation(s)
- David Giannandrea
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Carla Caponi
- Internal Medicine Unit, Gubbio/Gualdo Tadino Hospital, USL Umbria 1, Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Physiopathology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Michele Romoli
- Neurology Clinic, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Claudia Marando
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Antongiulio Gallina
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Erica Marsili
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Elisa Sacchini
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Sara Mastrocola
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Chiara Padiglioni
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Tatiana Mazzoli
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Silvia Cenciarelli
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | - Stefano Ricci
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| |
Collapse
|
10
|
Pretnar Oblak J, Sabovic M, Frol S. Intravenous Thrombolysis After Idarucizumab Application in Acute Stroke Patients—A Potentially Increased Sensitivity of Thrombi to Lysis? J Stroke Cerebrovasc Dis 2019; 28:768-773. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 12/21/2022] Open
|
11
|
Fang CW, Tsai YT, Chou PC, Chen HM, Lu CM, Tsao CR, Chen CL, Sun MC, Shih YS, Hsieh CY, Chen LA, Chen PL, Yeh JT, Li YH. Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan. J Stroke Cerebrovasc Dis 2018; 28:815-820. [PMID: 30573284 DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/19/2018] [Accepted: 11/29/2018] [Indexed: 12/27/2022] Open
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. 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. RESULTS Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA2DS2-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. CONCLUSION Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.
Collapse
Affiliation(s)
- Chen-Wen Fang
- Department of Neurology, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Yi-Te Tsai
- Department of Neurology, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Ping-Chen Chou
- Department of Neurology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Hsi-Ming Chen
- Department of Neurology, Ton Yen General Hospital, Hsinchu, Taiwan
| | - Chien-Ming Lu
- Department of Neurology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chen-Rong Tsao
- Department of Cardiology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chih-Lin Chen
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Mu-Chien Sun
- Stroke Center and Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Song Shih
- Department of Neurology, Yunlin Christian Hospital, Yunlin, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Lu-An Chen
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Po-Lin Chen
- Stroke Center, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jung-Tze Yeh
- Medical Department, Boehringer Ingelheim Taiwan Limited, Taipei, Taiwan
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|