Fang Chen-Wen, Tsai Yi-Te, Chou Ping-Chen, Chen Hsi-Ming, Lu Chien-Ming, Tsao Chen-Rong, Chen Chih-Lin, Sun Mu-Chien, Shih Yu-Song, Hsieh Cheng-Yang, Chen Lu-An, Chen Po-Lin, Yeh Jung-Tze, Li Yi-Heng
Department of Neurology, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan.
Department of Neurology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
J Stroke Cerebrovasc Dis. 2019 Mar;28(3):815-820. doi: 10.1016/j.jstrokecerebrovasdis.2018.11.029. Epub 2018 Dec 17.
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.
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.
Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHADS-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.
Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.
即使在接受非维生素K拮抗剂口服抗凝药治疗的情况下，亚洲房颤患者发生缺血性卒中的风险仍高于非亚洲人。本研究的目的是观察在台湾地区，达比加群治疗的急性缺血性卒中患者使用逆转剂依达赛珠单抗后进行静脉溶栓治疗的可行性。
本项全国性回顾性研究纳入了接受依达赛珠单抗逆转后静脉注射重组组织型纤溶酶原激活剂（rt-PA）的达比加群治疗的急性缺血性卒中患者。记录临床数据、治疗过程及预后情况。采用美国国立卫生研究院卒中量表（NIHSS）评分评估卒中严重程度。通过神经影像学检查检测rt-PA治疗后发生的任何颅内出血（ICH）。
纳入10例达比加群治疗的急性缺血性卒中患者（6例男性，平均年龄71.10±7.96岁）。卒中前，平均CHADS-VASc评分为4.50±1.57，8例患者（80%）每日两次服用110mg达比加群。所有患者均接受5g依达赛珠单抗治疗，随后活化部分凝血活酶时间恢复正常。静脉注射rt-PA（平均剂量0.78mg/kg）在依达赛珠单抗输注后平均11.11分钟开始。溶栓后NIHSS评分显著改善（入院时为16.0±6.67，出院时为9.38±4.75，P = 0.016）。3例患者（30%）发生ICH。其中2例无症状，1例发生有症状ICH导致死亡。
我们的数据再次证实了在依达赛珠单抗逆转达比加群作用后，静脉注射rt-PA对亚洲卒中患者的可行性。
