Dept of Vascular Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
J Thromb Thrombolysis. 2023 Apr;55(3):506-518. doi: 10.1007/s11239-023-02772-3. Epub 2023 Feb 4.
Reversal of dabigatran anticoagulation activity using idarucizumab is indicated for individuals suffering from life-threatening or non-controlled bleeding and those in need of urgent operation or invasive intervention. Through idarucizumab application patients with acute ischemic stroke (AIS) may regain eligibility for intravenous thrombolysis (IVT) and patients with intracranial hemorrhage (ICH) may show less hematoma growth, thereby improving functional outcome in both groups. However, evidence is limited, and international guidelines contain heterogenous recommendations substantiating the need for the review of evidence and standard operating procedures (SOPs).
For our review, we searched PubMed for all published articles using idarucizumab and ischemic stroke/hemorrhagic stroke as keywords. Illustrating two clinical cases, we discuss the current literature and national guidelines.
Our search retrieved 47 articles of which 8 case studies or series made public after 2020/2021, 28 reviews, 1 leading opinion article, 1 editorial and 10 guidelines. Summarizing the available evidence, idarucizumab application in stroke patients taking dabigatran results in decreased mortality rate and improved functional outcomes. Based on two clinical cases from our departments, we provide SOPs on how to deal with eligible patients in a time-efficient way, thereby reducing door-to-needle times in AIS and preventing early deterioration in ICH patients.
Reversal of dabigatran with idarucizumab in stroke patients appears easy to manage, safe and beneficial. The SOPs aim to reassure stroke physicians to include dabigatran reversal into their daily clinical routine when dealing with patients presenting with ischemic or hemorrhagic stroke under dabigatran therapy.
达比加群抗凝作用的逆转剂依达鲁单抗适用于有生命危险或不受控制的出血、需要紧急手术或侵入性干预的患者。通过依达鲁单抗的应用，患有急性缺血性脑卒中（AIS）的患者可能重新获得静脉溶栓（IVT）的资格，患有颅内出血（ICH）的患者可能显示血肿生长减少，从而改善两组患者的功能预后。然而，证据有限，国际指南包含不同的建议，证实有必要审查证据和标准操作程序（SOP）。
为了进行我们的综述，我们在 PubMed 上搜索了所有使用依达鲁单抗和缺血性脑卒中/出血性脑卒中作为关键词的已发表文章。通过展示两个临床病例，我们讨论了当前的文献和国家指南。
我们的搜索共检索到 47 篇文章，其中 8 篇病例研究或系列于 2020/2021 年后发表，28 篇综述，1 篇主要观点文章，1 篇社论和 10 篇指南。总结现有证据，达比加群抗凝作用的逆转剂依达鲁单抗在服用达比加群的脑卒中患者中的应用可降低死亡率和改善功能预后。基于我们科室的两个临床病例，我们提供了处理符合条件的患者的 SOP，从而减少 AIS 中的门到针时间，并防止 ICH 患者的早期恶化。
在脑卒中患者中，用依达鲁单抗逆转达比加群似乎易于管理、安全且有益。SOP 的目的是让脑卒中医生在处理接受达比加群治疗的缺血性或出血性脑卒中患者时，将达比加群逆转纳入其日常临床常规。
