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@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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