Xie Dan, Wang Xuefan, Li Yao, Chen Ruiling, Zhao Yingying, Xu Chunling, Zhang Qian, Zhang Yongbo
Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Aging Neurosci. 2021 Dec 14;13:765037. doi: 10.3389/fnagi.2021.765037. eCollection 2021.
As there is a growing concern about the cerebral embolism events secondary to non-valvular atrial fibrillation (NVAF), novel oral anticoagulant (NOAC) has been more and more widely used as an anticoagulation treatment for the prevention of stroke. However, in the face of life-threatening bleeding or emergency surgery/treatment, NOAC-related antagonists such as idarucizumab need to be urgently used to reverse the NOAC. Using recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis for acute ischemic stroke requires a time window of 4.5 h. This case reports rt-PA intravenous thrombolysis after reversal of dabigatran anticoagulation with idarucizumab in patients with acute ischemic stroke. We report the case of 62-year-old Chinese female with NVAF treated with dabigatran 110 mg twice daily, and missed a dose on the eve of the stroke. The patient presented with acute ischemic stroke causing the angle of mouth deviated to right side and left limb weakness in the early morning of the next day. However, the last dosing time of dabigatran was between 24 and 48 h, the patients were given rt-PA intravenous thrombolysis after reversal of dabigatran anticoagulation with idarucizumab, while any potential relative contraindication had been excluded by means of laboratory test and CT scan in the hospitalization services. National Institute of Health stroke scale (NIHSS) score was reduced from 4 to 1, and the patient was discharged after 2 weeks. Our case report adds to the evidence that idarucizumab administration is safe and effective in the setting of patients with atrial fibrillation treated with dabigatran who develop acute ischemic stroke requiring rt-PA intravenous thrombolysis.
由于非瓣膜性心房颤动（NVAF）继发的脑栓塞事件日益受到关注，新型口服抗凝药（NOAC）作为预防中风的抗凝治疗方法已被越来越广泛地使用。然而，面对危及生命的出血或紧急手术/治疗时，需要紧急使用idarucizumab等NOAC相关拮抗剂来逆转NOAC的作用。使用重组组织型纤溶酶原激活剂（rt-PA）进行急性缺血性中风的静脉溶栓治疗需要4.5小时的时间窗。本病例报告了在急性缺血性中风患者中，使用idarucizumab逆转达比加群抗凝作用后进行rt-PA静脉溶栓的情况。我们报告了一例62岁中国女性NVAF患者，每日两次服用110mg达比加群，中风前夕漏服一剂。次日清晨，患者出现急性缺血性中风，导致口角向右侧偏斜和左下肢无力。然而，达比加群的最后给药时间在24至48小时之间，在排除了所有潜在的相对禁忌症后，通过实验室检查和住院期间的CT扫描，使用idarucizumab逆转达比加群抗凝作用后，对患者进行了rt-PA静脉溶栓。美国国立卫生研究院卒中量表（NIHSS）评分从4分降至1分，患者在2周后出院。我们的病例报告进一步证明，对于服用达比加群治疗的心房颤动患者发生急性缺血性中风需要进行rt-PA静脉溶栓时，给予idarucizumab是安全有效的。
