Intravenous Thrombolysis in Patients with Acute Ischemic Stroke
after a Reversal of Dabigatran Anticoagulation with
Idarucizumab: A Real-World Clinical Experience

J 2018

Intravenous Thrombolysis in Patients with Acute Ischemic Stroke after a Reversal of Dabigatran Anticoagulation with Idarucizumab: A Real-World Clinical Experience

ŠAŇÁK, Daniel, Stanislava JAKUBÍČEK, David ČERNÍK, Roman HERZIG, Zdeněk KUNÁŠ et. al.

Basic information

Original name

Intravenous Thrombolysis in Patients with Acute Ischemic Stroke after a Reversal of Dabigatran Anticoagulation with Idarucizumab: A Real-World Clinical Experience

Authors

ŠAŇÁK, Daniel (203 Czech Republic, guarantor), Stanislava JAKUBÍČEK (703 Slovakia, belonging to the institution), David ČERNÍK (203 Czech Republic), Roman HERZIG (203 Czech Republic), Zdeněk KUNÁŠ (203 Czech Republic), Robert MIKULÍK (203 Czech Republic), Svatopluk OSTRÝ (203 Czech Republic), Michal REIF (203 Czech Republic), Vladimír ROHAN (203 Czech Republic), Aleš TOMEK (203 Czech Republic) and Tomáš VEVERKA (203 Czech Republic)

Edition

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, AMSTERDAM, ELSEVIER SCIENCE BV, 2018, 1052-3057

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30103 Neurosciences

Country of publisher

Netherlands

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 1.646

RIV identification code

RIV/00216224:14110/18:00104196

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.004

UT WoS

000441086000034

Keywords in English

Acute ischemic stroke; intravenous thrombolysis; anticoagulation; dabigatran; antidote; reversal

Abstract

V originále

Background: Intravenous thrombolysis (IVT) is contraindicated in patients with acute ischemic stroke (AIS) using oral anticoagulants. A specific human monoclonal antibody was introduced to reverse immediately the anticoagulation effect of the direct inhibitor of thrombin, dabigatran. Until now, mostly individual cases presenting with successful IVT after a reversal of dabigatran anticoagulation in patients with AIS were published. Thus, we aimed to report real-world data from clinical practice. Methods: Patients with AIS on dabigatran treated with IVT after antidote reversal were enrolled in the retrospective nationwide study. Neurological deficit was scored using the National Institutes of Health Stroke Scale (NIHSS) and 90-day clinical outcome using modified Rankin scale (mRS) with a score 0-2 for a good outcome. Intracerebral hemorrhage (ICH) was defined as a presence of any sign of bleeding on control imaging after IVT, and symptomatic intracerebral hemorrhage (SICH) was assessed according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria. Results: In total, 13 patients (7 men, mean age 70.0 +/- 9.1 years) with a median NIHSS admission score of 7 points were analyzed. Of these patients, 61.5% used 2 x 150 mg of dabigatran daily. Antidote was administrated 427 +/- 235 minutes after the last intake of dabigatran, with a mean activated prothrombin time of 38.1 +/- 27.8 seconds and a mean thrombin time of 72.2 +/- 56.1 seconds. Of the 13 patients, 2 had ICH and 1 had SICH, and no other bleeding complications were observed after IVT. Of the total number of patients, 76.9% had a good 3-month clinical outcome and 3 patients (23.1%) died. Recurrent ischemic stroke occurred in 2 patients (15.4%). Conclusion: The data presented in the study support the safety and efficacy of IVT after the reversal of the anticoagulation effect of dabigatran with antidote in a real-world clinical practice.

Citovat

ŠAŇÁK, Daniel, Stanislava JAKUBÍČEK, David ČERNÍK, Roman HERZIG, Zdeněk KUNÁŠ, Robert MIKULÍK, Svatopluk OSTRÝ, Michal REIF, Vladimír ROHAN, Aleš TOMEK and Tomáš VEVERKA. Intravenous Thrombolysis in Patients with Acute Ischemic Stroke after a Reversal of Dabigatran Anticoagulation with Idarucizumab: A Real-World Clinical Experience. JOURNAL OF STROKE & CEREBROVASCULAR DISEASES. AMSTERDAM: ELSEVIER SCIENCE BV, 2018, vol. 27, No 9, p. 2479-2483. ISSN 1052-3057. Available from: https://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.004.

@article{1455261,
   author = {Šaňák, Daniel and Jakubíček, Stanislava and Černík, David and Herzig, Roman and Kunáš, Zdeněk and Mikulík, Robert and Ostrý, Svatopluk and Reif, Michal and Rohan, Vladimír and Tomek, Aleš and Veverka, Tomáš},
   article_location = {AMSTERDAM},
   article_number = {9},
   doi = {http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.004},
   keywords = {Acute ischemic stroke; intravenous thrombolysis; anticoagulation; dabigatran; antidote; reversal},
   language = {eng},
   issn = {1052-3057},
   journal = {JOURNAL OF STROKE & CEREBROVASCULAR DISEASES},
   title = {Intravenous Thrombolysis in Patients with Acute Ischemic Stroke after a Reversal of Dabigatran Anticoagulation with Idarucizumab: A Real-World Clinical Experience},
   volume = {27},
   year = {2018}
}

TY  - JOUR
ID  - 1455261
AU  - Šaňák, Daniel - Jakubíček, Stanislava - Černík, David - Herzig, Roman - Kunáš, Zdeněk - Mikulík, Robert - Ostrý, Svatopluk - Reif, Michal - Rohan, Vladimír - Tomek, Aleš - Veverka, Tomáš
PY  - 2018
TI  - Intravenous Thrombolysis in Patients with Acute Ischemic Stroke after a Reversal of Dabigatran Anticoagulation with Idarucizumab: A Real-World Clinical Experience
JF  - JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
VL  - 27
IS  - 9
SP  - 2479-2483
EP  - 2479-2483
PB  - ELSEVIER SCIENCE BV
SN  - 10523057
KW  - Acute ischemic stroke
KW  - intravenous thrombolysis
KW  - anticoagulation
KW  - dabigatran
KW  - antidote
KW  - reversal
N2  - Background: Intravenous thrombolysis (IVT) is contraindicated in patients with acute ischemic stroke (AIS) using oral anticoagulants. A specific human monoclonal antibody was introduced to reverse immediately the anticoagulation effect of the direct inhibitor of thrombin, dabigatran. Until now, mostly individual cases presenting with successful IVT after a reversal of dabigatran anticoagulation in patients with AIS were published. Thus, we aimed to report real-world data from clinical practice. Methods: Patients with AIS on dabigatran treated with IVT after antidote reversal were enrolled in the retrospective nationwide study. Neurological deficit was scored using the National Institutes of Health Stroke Scale (NIHSS) and 90-day clinical outcome using modified Rankin scale (mRS) with a score 0-2 for a good outcome. Intracerebral hemorrhage (ICH) was defined as a presence of any sign of bleeding on control imaging after IVT, and symptomatic intracerebral hemorrhage (SICH) was assessed according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria. Results: In total, 13 patients (7 men, mean age 70.0 +/- 9.1 years) with a median NIHSS admission score of 7 points were analyzed. Of these patients, 61.5% used 2 x 150 mg of dabigatran daily. Antidote was administrated 427 +/- 235 minutes after the last intake of dabigatran, with a mean activated prothrombin time of 38.1 +/- 27.8 seconds and a mean thrombin time of 72.2 +/- 56.1 seconds. Of the 13 patients, 2 had ICH and 1 had SICH, and no other bleeding complications were observed after IVT. Of the total number of patients, 76.9% had a good 3-month clinical outcome and 3 patients (23.1%) died. Recurrent ischemic stroke occurred in 2 patients (15.4%). Conclusion: The data presented in the study support the safety and efficacy of IVT after the reversal of the anticoagulation effect of dabigatran with antidote in a real-world clinical practice.
ER  -

ŠAŇÁK, Daniel, Stanislava JAKUBÍČEK, David ČERNÍK, Roman HERZIG, Zdeněk KUNÁŠ, Robert MIKULÍK, Svatopluk OSTRÝ, Michal REIF, Vladimír ROHAN, Aleš TOMEK and Tomáš VEVERKA. Intravenous Thrombolysis in Patients with Acute Ischemic Stroke after a Reversal of Dabigatran Anticoagulation with Idarucizumab: A Real-World Clinical Experience. \textit{JOURNAL OF STROKE \&{}amp; CEREBROVASCULAR DISEASES}. AMSTERDAM: ELSEVIER SCIENCE BV, 2018, vol.~27, No~9, p.~2479-2483. ISSN~1052-3057. Available from: https://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.004.

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