Intravenous stroke thrombolysis after reversal of dabigatran effect by idarucizumab: first reported case in Hong Kong

Lo, WT; Ng, KF; Chan, Simon; Kwok, Vivian WY; Fong, CS; St, Chan; Wong, Gordon CK; Fong, WC

doi:10.12809/hkmj166231

Cited by 6 publications

(1 citation statement)

References 4 publications

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“…The specific and rapid effect of idarucizumab as an antidote for dabigatran without an effect on the coagulation cascade may permit us to reverse the activity of dabigatran in patients with hyperacute stroke and then to perform IVT. A total of 47 cases following this new strategy were collected without overlap from 21 articles that were published in English up to February 2018 and could be identified using PubMed with the search terms ‘stroke’ and ‘idarucizumab.’ [ 32 - 52 ] One case in our institute was added. Table 3 shows the background characteristics and clinical courses of the 48 cases (23 women, median 76.5 years old).…”

Section: A New Strategy For Acute Reperfusion Therapy Following Adminmentioning

confidence: 99%

Consensus Guides on Stroke Thrombolysis for Anticoagulated Patients from Japan: Application to Other Populations

2018

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Development of direct oral anticoagulants and their antidotes has led to the need to reconsider the eligibility of acute stroke patients who have been taking oral anticoagulants for intravenous thrombolysis. Officially authorized Japanese guidelines on this issue were revised twice at the time of approval for clinical use of direct oral anticoagulants and idarucizumab, a specific reversal agent for dabigatran. A unique recommendation in the latest Japanese clinical guides was that thrombolysis can be recommended if the time of the last dose of direct oral anticoagulants exceeds 4 hours and if commonly available anticoagulation markers are normal or subnormal, i.e., international normalized ratio of prothrombin time <1.7 and activated partial thromboplastin time <1.5 times the baseline value (≤40 seconds only as a guide). These criteria are partly supported by the findings of domestic multicenter and single-center surveys that symptomatic or asymptomatic intracranial hemorrhage following thrombolysis was rare under the conditions of the criteria. Even for dabigatran users, stroke thrombolysis can be considered without pretreatment by idarucizumab if patients meet the above criteria. If not, direct mechanical thrombectomy can be considered without pretreatment by idarucizumab or thrombolysis, and use of idarucizumab, followed immediately by thrombolysis, can be considered only when thrombectomy cannot be quickly performed. These clinical guides are practical and to some extent economical, but they have some limitations, including lack of corroborating information from sufficient numbers of relevant cases. The guides will be further modified based on the results of future research.

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Section: A New Strategy For Acute Reperfusion Therapy Following Adminmentioning

confidence: 99%

Consensus Guides on Stroke Thrombolysis for Anticoagulated Patients from Japan: Application to Other Populations

2018

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show abstract

Standard operating procedure for idarucizumab reversal of dabigatran anticoagulation in ischemic and hemorrhagic stroke

Frol

Oblak²,

Šabovič³

et al. 2023

J Thromb Thrombolysis

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Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan

Fang

Tsai

Chou

et al. 2019

Journal of Stroke and Cerebrovascular Diseases

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Intravenous stroke thrombolysis after reversal of dabigatran effect by idarucizumab: first reported case in Hong Kong

Cited by 6 publications

References 4 publications

Consensus Guides on Stroke Thrombolysis for Anticoagulated Patients from Japan: Application to Other Populations

Consensus Guides on Stroke Thrombolysis for Anticoagulated Patients from Japan: Application to Other Populations

Standard operating procedure for idarucizumab reversal of dabigatran anticoagulation in ischemic and hemorrhagic stroke

Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan

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