Successful intravenous thrombolysis in acute ischemic stroke after reversal of dabigatran etexilate with idarucizumab at the end of therapeutic time window.

Dabigatran is a direct oral anticoagulant that is widely used for stroke prevention in patients with atrial fibrillation. We report a case of an 80-year-old stroke patient on dabigatran for permanent atrial fibrillation, who presented with an initial National Institutes of Health Stroke Scale (NIHSS) of 8. Dabigatran was reversed with idarucizumab, and intravenous tissue-type plasminogen activator (IV-tPA) was administrated beginning 4 h and 28 min after the symptom onset. The patient was discharged with an NIHSS of 1. Our case is an additional proof of safety and efficiency of idarucizumab in the clinical setting of ischemic stroke before the administration of IV-tPA.