Systemic Thrombolysis in Acute Ischemic Stroke after Dabigatran Etexilate Reversal with Idarucizumab-A Case Report.

INTRODUCTION: Idarucizumab is a reversal agent for dabigatran etexilate. By reversing the anticoagulating effect of dabigatran etexilate with idarucizumab (Praxbind), patients presenting with an acute ischemic stroke can now be eligible for thrombolysis.

PATIENT: We describe our experience with idarucizumab in a 71-year-old male patient pretreated with dabigatran etexilate. The patient arrived with a hemiparesis, central facial palsy, and dysarthria.

METHOD: Dabigatran etexilate was antagonized with idarucizumab, approximately 2.5 hours after the patient's last dose. Immediately after the infusion of idarucizumab, the patient received thrombolytic therapy.

RESULTS: The hemiparesis and the central facial palsy were fully remitted 3 days after the onset of symptoms, and the dysarthria was remitted 2 days afterwards.

DISCUSSION: Non-vitamin K oral anticoagulants (NOACs) are widely used for the prevention of embolic stroke in patients with atrial fibrillation. Dabigatran etexilate is an oral thrombin inhibitor that can be reversed by idarucizumab. Idarucizumab, a monoclonal antibody fragment, directly binds dabigatran etexilate and neutralizes its activity.

CONCLUSION: Reversal of dabigatran etexilate using idarucizumab was safe and successful with no recombinant tissue plasminogen activator interactions.