PMID- 27301937
OWN - NLM
STAT- MEDLINE
DCOM- 20170523
LR  - 20170523
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 47
IP  - 7
DP  - 2016 Jul
TI  - Intravenous Thrombolysis With Recombinant Tissue-Type Plasminogen Activator in a 
      Stroke Patient Receiving Dabigatran Anticoagulant After Antagonization With
      Idarucizumab.
PG  - 1936-8
LID - 10.1161/STROKEAHA.116.013550 [doi]
AB  - BACKGROUND AND PURPOSE: Therapeutic options for acute ischemic stroke patients
      presenting on effective anticoagulation are limited. Idarucizumab, a humanized,
      monoclonal antibody fragment for immediate reversal of dabigatran, may allow this
      subgroup of orally anticoagulated patients to regain eligibility for
      thrombolysis. METHODS: We report the first successful acute antagonization of
      dabigatran by idarucizumab before intravenous thrombolysis with recombinant
      tissue-type plasminogen activator. RESULTS: Idarucizumab was given to a
      76-year-old male patient on dabigatran approximately 3.5 hours after his last
      dose. Neurological status on admission was NIHSS (National Institutes of Health
      Stroke Scale) 11. Recombinant tissue-type plasminogen activator was initiated
      immediately after dabigatran reversal. The patient was discharged with a
      favorable outcome of NHISS 1 on day 7. No complications were observed.
      CONCLUSIONS: This case represents a new therapeutic paradigm. It is further
      supported by in vitro data showing no nonspecific interactions of idarucizumab
      with recombinant tissue-type plasminogen activator-induced thrombolysis. Thus,
      patients effectively anticoagulated with dabigatran who were previously
      contraindicated for thrombolytic therapy in this situation may now receive
      treatment because of the ability to rapidly reverse the anticoagulant activity of
      dabigatran with idarucizumab.
CI  - (c) 2016 American Heart Association, Inc.
FAU - Berrouschot, Jorg
AU  - Berrouschot J
AD  - From the Department of Neurology, Klinikum Altenburger Land GmbH, Altenburg,
      Germany (J.B., A.S., T.H.); and Medical Affairs Germany, Boehringer Ingelheim
      Pharma GmbH & Co KG, Ingelheim am Rhein, Germany (C.C.E.).
      joerg.berrouschot@klinikum-altenburgerland.de.
FAU - Stoll, Anett
AU  - Stoll A
AD  - From the Department of Neurology, Klinikum Altenburger Land GmbH, Altenburg,
      Germany (J.B., A.S., T.H.); and Medical Affairs Germany, Boehringer Ingelheim
      Pharma GmbH & Co KG, Ingelheim am Rhein, Germany (C.C.E.).
FAU - Hogh, Theresa
AU  - Hogh T
AD  - From the Department of Neurology, Klinikum Altenburger Land GmbH, Altenburg,
      Germany (J.B., A.S., T.H.); and Medical Affairs Germany, Boehringer Ingelheim
      Pharma GmbH & Co KG, Ingelheim am Rhein, Germany (C.C.E.).
FAU - Eschenfelder, Christoph Cyrill
AU  - Eschenfelder CC
AD  - From the Department of Neurology, Klinikum Altenburger Land GmbH, Altenburg,
      Germany (J.B., A.S., T.H.); and Medical Affairs Germany, Boehringer Ingelheim
      Pharma GmbH & Co KG, Ingelheim am Rhein, Germany (C.C.E.).
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20160614
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Antidotes)
RN  - 0 (Recombinant Proteins)
RN  - 97RWB5S1U6 (idarucizumab)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - I0VM4M70GC (Dabigatran)
SB  - IM
MH  - Aged
MH  - Antibodies, Monoclonal, Humanized/*therapeutic use
MH  - Antidotes/therapeutic use
MH  - Atrial Fibrillation/complications
MH  - Brain Ischemia/complications/*drug therapy
MH  - Dabigatran/*antagonists & inhibitors/therapeutic use
MH  - Diabetes Mellitus, Type 2/complications/diet therapy
MH  - Humans
MH  - Hypertension/complications
MH  - Infarction, Middle Cerebral Artery/etiology
MH  - Male
MH  - Paresis/etiology
MH  - Recombinant Proteins/administration & dosage/therapeutic use
MH  - Recovery of Function
MH  - Severity of Illness Index
MH  - *Thrombolytic Therapy
MH  - Thrombophilia/drug therapy/etiology
MH  - Tissue Plasminogen Activator/administration & dosage/*therapeutic use
OTO - NOTNLM
OT  - *anticoagulants
OT  - *antidotes
OT  - *dabigatran
OT  - *idarucizumab
OT  - *stroke
EDAT- 2016/06/16 06:00
MHDA- 2017/05/24 06:00
CRDT- 2016/06/16 06:00
PHST- 2016/04/01 00:00 [received]
PHST- 2016/05/17 00:00 [accepted]
PHST- 2016/06/16 06:00 [entrez]
PHST- 2016/06/16 06:00 [pubmed]
PHST- 2017/05/24 06:00 [medline]
AID - STROKEAHA.116.013550 [pii]
AID - 10.1161/STROKEAHA.116.013550 [doi]
PST - ppublish
SO  - Stroke. 2016 Jul;47(7):1936-8. doi: 10.1161/STROKEAHA.116.013550. Epub 2016 Jun
      14.