Chen-Wen Fang1, Yi-Te Tsai1, Ping-Chen Chou2, Hsi-Ming Chen3, Chien-Ming Lu4, Chen-Rong Tsao5, Chih-Lin Chen6, Mu-Chien Sun7, Yu-Song Shih8, Cheng-Yang Hsieh9, Lu-An Chen10, Po-Lin Chen11, Jung-Tze Yeh12, Yi-Heng Li13. 1. Department of Neurology, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan. 2. Department of Neurology, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan. 3. Department of Neurology, Ton Yen General Hospital, Hsinchu, Taiwan. 4. Department of Neurology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan. 5. Department of Cardiology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan. 6. Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan. 7. Stroke Center and Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan. 8. Department of Neurology, Yunlin Christian Hospital, Yunlin, Taiwan. 9. Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan. 10. Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan. 11. Stroke Center, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan. 12. Medical Department, Boehringer Ingelheim Taiwan Limited, Taipei, Taiwan. 13. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: heng@mail.ncku.edu.tw.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA2DS2-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. CONCLUSION: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.
BACKGROUND: 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. METHODS: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. RESULTS: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA2DS2-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. CONCLUSION: Our data reconfirmed the feasibility of intravenous rt-PA for Asian strokepatients after reversal of dabigatran effect with idarucizumab.
Authors: Duncan Wilson; Teddy Y Wu; David J Seiffge; Thomas Meinel; Jan Christoph Purrucker; Johannes Kaesmacher; Urs Fischer Journal: J Neurol Neurosurg Psychiatry Date: 2021-02-04 Impact factor: 10.154