Kafke Waldemar, Kraft Peter
Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
Case Rep Neurol. 2016 Jun 27;8(2):140-4. doi: 10.1159/000447531. eCollection 2016 May-Aug.
We describe a 75-year-old female patient with nonvalvular atrial fibrillation who presented with acute ischemic stroke during treatment with dabigatran 2 × 110 mg per day. After informed consent, we reversed the anticoagulant effects of dabigatran using idarucizumab and applied an intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (off-label use). An intracerebral hemorrhage was excluded after systemic thrombolysis. Despite the IVT, the patient's clinical condition deteriorated and she developed an ischemic lesion in the right pons, the right thalamus and right cerebellum. To date, the literature lacks data concerning the thrombolytic treatment of acute ischemic stroke in patients after specific reversal of the non-vitamin K oral anticoagulant dabigatran using idarucizumab. Given the rapid and sustainable efficacy of idarucizumab, the reversal of dabigatran followed by thrombolysis seems to be safe, but further studies and register data are still needed to confirm our preliminary observation, especially to provide additional data concerning the risk-benefit evaluation.
我们描述了一名75岁的非瓣膜性心房颤动女性患者，在接受每日2次、每次110 mg达比加群治疗期间出现急性缺血性卒中。在获得知情同意后，我们使用艾达赛珠单抗逆转达比加群的抗凝作用，并应用重组组织型纤溶酶原激活剂进行静脉溶栓（超说明书使用）。全身溶栓后排除了脑出血。尽管进行了静脉溶栓，但患者的临床状况仍恶化，右侧脑桥、右侧丘脑和右侧小脑出现缺血性病变。迄今为止，文献中缺乏关于使用艾达赛珠单抗特异性逆转非维生素K口服抗凝剂达比加群后急性缺血性卒中患者溶栓治疗的数据。鉴于艾达赛珠单抗快速且持续的疗效，达比加群逆转后进行溶栓似乎是安全的，但仍需要进一步的研究和登记数据来证实我们的初步观察结果，特别是提供有关风险效益评估的更多数据。
