Successful Thrombolytic Therapy With Recombinant Tissue Plasminogen Activator in Ischemic Stroke After Idarucizumab Administration for Reversal of Dabigatran

A Case Report

Toshiyuki Ohtani; Ryosuke Sintoku; Tasuku Yajima; Naoyuki Kaneko


J Med Case Reports. 2019;13(390) 

In This Article


Although direct oral anticoagulants (DOACs) are widely used for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), ischemic stroke can still occur in patients undergoing treatment with DOACs. Furthermore, when an ischemic attack occurs, DOACs are associated with a high risk of hemorrhage, especially in patients requiring thrombolytic therapy. Idarucizumab, a humanized monoclonal antibody fragment, is a specific antidote that can reverse the anticoagulant effect of dabigatran, one of the widely used DOACs, rapidly and completely within a few minutes after injection.[1] Although a newer intravenous thrombolytic (IVT) therapy with recombinant tissue plasminogen activator (rt-PA) has been proposed after injection of idarucizumab in patients receiving dabigatran,[2,3] the safety and efficacy of this therapy are equivocal because of the limited number of reported cases. We present a case of a patient with acute lacunar infarct who was successfully treated by IVT therapy with rt-PA after using idarucizumab.