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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Pikija, S; Sztriha, LK; Sebastian, Mutzenbach, J; Golaszewski, SM; Sellner, J.
Idarucizumab in Dabigatran-Treated Patients with Acute Ischemic Stroke Receiving Alteplase: A Systematic Review of the Available Evidence.
CNS Drugs. 2017; 31(9): 747-757. Doi: 10.1007/s40263-017-0460-x [OPEN ACCESS]
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Führende Autor*innen der Med Uni Graz

Pikija Slaven

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Abstract:

BACKGROUND AND PURPOSE: Current guidelines do not recommend the use of intravenous recombinant tissue plasminogen activator in patients with acute ischemic stroke who receive direct oral anticoagulants. While the humanized monoclonal antibody idarucizumab can quickly reverse the anticoagulant effects of the thrombin inhibitor dabigatran, safety data for subsequent tissue plasminogen activator treatment are sparse. Here, we review current knowledge about dabigatran reversal prior to systemic reperfusion treatment in acute ischemic stroke. METHODS: We performed a systematic review of all published cases of intravenous tissue plasminogen activator treatment following the administration of a dabigatran antidote up to June 2017 and added five unpublished cases of our own. We analyzed clinical and radiological outcomes, symptomatic post-thrombolysis intracranial hemorrhage, and other serious systemic bleeding. Additional endpoints were allergic reaction to idarucizumab, and venous thrombosis in the post-acute phase. RESULTS: We identified a total of 21 patients (71% male) with a median age of 76 years (interquartile range 70-84). The median National Institute of Health Stroke Scale score at baseline was 10 (n = 20, interquartile range 5-11) and 18/20 patients (90%) had mild or moderate stroke severity. The time from symptom onset to start of tissue plasminogen activator was 155 min (n = 18, interquartile range 122-214). The outcome was unfavorable in 3/19 patients (16%). There was one fatality as a result of a symptomatic post-thrombolysis intracranial hemorrhage, and two patients experienced an increase in the National Institute of Health Stroke Scale compared with baseline. One patient had a recurrent stroke. No systemic bleeding, venous thrombosis, or allergic reactions were reported. CONCLUSION: Experience with idarucizumab administration prior to tissue plasminogen activator treatment in acute ischemic stroke is limited. Initial clinical experience in less severe stroke syndromes and short time windows seems favorable. Larger cohorts are required to confirm safety, including bleeding complications and the risk of thrombosis.

Find related publications in this database (using NLM MeSH Indexing)

Administration, Intravenous - administration & dosage

Aged - administration & dosage

Aged, 80 and over - administration & dosage

Animals - administration & dosage

Antibodies, Monoclonal, Humanized - therapeutic use

Antithrombins - administration & dosage, adverse effects

Brain Ischemia - drug therapy

Dabigatran - administration & dosage, adverse effects

Female - administration & dosage

Hemorrhage - chemically induced

Humans - administration & dosage

Male - administration & dosage

Practice Guidelines as Topic - administration & dosage

Stroke - drug therapy

Tissue Plasminogen Activator - administration & dosage, adverse effects

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