Gawehn Annemarie, Ayari Yassine, Heuschkel Christian, Kaste Matthias, Kermer Pawel
Department of Neurology, Nordwest-Krankenhaus Sanderbusch GmbH, Am Gut Sanderbusch 1, 26452, Sande, Germany.
Academic Clinical Department, University Medical Center Gottingen, Gottingen, Germany.
J Med Case Rep. 2016 Sep 29;10(1):269. doi: 10.1186/s13256-016-1050-0.
Effective anticoagulation routinely precludes patients from receiving intravenous thrombolysis with recombinant tissue plasminogen activator to reverse severe symptoms of ischemic stroke. We report what we believe to be the first case of ischemic stroke successfully treated with recombinant tissue plasminogen activator after antagonizing dabigatran with the monoclonal antibody idarucizumab, recently approved worldwide.
A 75-year-old Caucasian man presented to our hospital with severe aphasia and mild hemiparesis. After providing written consent, he received two doses of 2.5 g of idarucizumab over 20 minutes followed by standard protocol in-label recombinant tissue plasminogen activator application. All symptoms resolved within 1 h.
Applying a recombinant tissue plasminogen activator after antagonizing dabigatran with idarucizumab is feasible and easy to manage in an emergency room or stroke unit. Thus, idarucizumab represents a new therapeutic option for patients receiving dabigatran treatment, reestablishing their eligibility for recombinant tissue plasminogen activator thrombolysis.
有效的抗凝治疗通常会使患者无法接受重组组织型纤溶酶原激活剂静脉溶栓以逆转缺血性卒中的严重症状。我们报告了我们认为是首例在使用全球最近获批的单克隆抗体艾达司珠单抗拮抗达比加群后成功用重组组织型纤溶酶原激活剂治疗缺血性卒中的病例。
一名75岁的白人男性因严重失语和轻度偏瘫入住我院。在获得书面同意后，他在20分钟内接受了两剂2.5g的艾达司珠单抗，随后按照标准方案应用标签内重组组织型纤溶酶原激活剂。所有症状在1小时内消失。
在使用艾达司珠单抗拮抗达比加群后应用重组组织型纤溶酶原激活剂在急诊室或卒中单元是可行且易于管理的。因此，艾达司珠单抗为接受达比加群治疗的患者提供了一种新的治疗选择，恢复了他们接受重组组织型纤溶酶原激活剂溶栓的资格。
