Agosti Sergio, Casalino Laura, Rocci Enrico, Zaccone Gabriele, Rota Eugenia
Cardiology Department, San Giacomo Hospital, Novi Ligure, Alessandria, Italy.
Cardiology Unit, ASL 3, Genoa, Italy.
J Med Case Rep. 2017 Aug 15;11(1):224. doi: 10.1186/s13256-017-1404-2.
Non-vitamin K antagonist oral anticoagulants, including dabigatran, are currently widely used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Recently, idarucizumab, a monoclonal antibody fragment for immediate reversal of dabigatran-induced anticoagulation, has been introduced into the market to be used in life-threatening bleeding or urgent surgery, allowing for rapid normalization of clotting parameters. The use of idarucizumab is not yet well established in patients presenting with acute ischemic stroke on dabigatran who are candidates for thrombolytic therapy.
We report the case of a 71-year-old hypertensive Caucasian woman with non-valvular atrial fibrillation treated with dabigatran 150 mg twice daily, who presented with acute ischemic stroke causing right-sided hemiparesis and aphasia. Two hours after presentation to the emergency department, a decision was made to administer idarucizumab for achieving complete reversal of any potential anticoagulant effect of dabigatran and, in the absence of any contraindications, our patient underwent successful thrombolysis. At discharge, our patient was able to walk unassisted and had only residual aphasia. Twenty days later, she had completely recovered motor function of her right side, with further progressive improvement of aphasia. Repeat cranial computed tomography confirmed the absence of hemorrhage, and anticoagulant therapy with dabigatran 150 mg twice daily was resumed.
Our case report adds to the evidence that idarucizumab administration is safe in the setting of patients with atrial fibrillation treated with dabigatran who develop acute ischemic stroke requiring thrombolysis.
包括达比加群在内的非维生素K拮抗剂口服抗凝药目前广泛用于预防非瓣膜性心房颤动患者的中风和全身性栓塞。最近，艾达赛珠单抗，一种用于立即逆转达比加群诱导的抗凝作用的单克隆抗体片段，已投放市场，用于治疗危及生命的出血或紧急手术，可使凝血参数迅速恢复正常。在接受达比加群治疗且有溶栓治疗指征的急性缺血性卒中患者中，艾达赛珠单抗的应用尚未得到充分证实。
我们报告了一例71岁患有高血压的白种非瓣膜性心房颤动女性患者，她接受每日两次150毫克达比加群治疗，出现急性缺血性卒中，导致右侧偏瘫和失语。在急诊科就诊两小时后，决定给予艾达赛珠单抗以完全逆转达比加群的任何潜在抗凝作用，在没有任何禁忌证的情况下，我们的患者成功接受了溶栓治疗。出院时，我们的患者能够独立行走，仅遗留失语。二十天后，她右侧肢体运动功能完全恢复，失语症状进一步逐步改善。重复头颅计算机断层扫描证实无出血，遂恢复每日两次150毫克达比加群的抗凝治疗。
我们的病例报告进一步证明，对于接受达比加群治疗且发生需要溶栓的急性缺血性卒中的心房颤动患者，给予艾达赛珠单抗是安全的。
